Telephone consultation requires appropriate training

Editor—In their overview of the role of telephone consultation in primary care Car and Sheikh point out the potential for improving access for patients and reducing general practitioners' workload.¹ We have two important observations from five years of running telephone consultation skills courses with members of primary care teams.

Firstly, all health professionals conducting telephone consultations need to provide a “safety net” for callers—for example, by ensuring that they are given explicit permission and directions to call back if symptoms change or the patient's condition worsens. In our experience, participative professional development courses can both raise awareness of such issues and increase confidence in managing calls.²

Secondly, primary care nurses locally report a high rate of telephone contacts, which, if representative, indicates a hitherto undocumented increase in telephone consulting by nurses.³ However, evidence from participants on our courses indicates that issues of clinical governance for nurses may be more complex and less well explored than the medicolegal issues for general practitioners. Unlike colleagues employed by NHS Direct, who work within explicit clinical governance frameworks,⁴ nurses in general practice need to satisfy themselves that they are within the boundaries of their professional competence, be aware of the limitations imposed by lack of visual cues (and develop strategies to minimise them),⁵ and be aware of the need to treat all telephone contacts with patients as consultations and have the appropriate professional and organisational support to do so.

Given the likely continued expansion of telephone consulting by all health professionals, appropriate training should be a requirement for general practitioner registrars and primary care nurses. In addition, primary care trusts should provide guidance on appropriate clinical governance frameworks.