Advanced Access

We welcome the recent evaluation of Advanced Access as reported in the Journal.¹ We were interested to read that telephone triage was regarded as the most and the least successful intervention. In our study on telephone triage the practice did not ‘advertise’ the operation of a triage service.² Mostly it was unnecessary to triage patients due to the ready availability of appointments. Only when all available appointments were taken was it necessary to fall back to negotiation with the patient. Had all patients been triaged it is possible that some patients would have made a habit of accessing care by telephone rather than by seeking appointments.

In relation to the impact on older patients we recently surveyed 900 patients receiving telephone consultations. The questionnaire included the Patient Enablement Instrument (PEI), a measure of the patients self-reported ability to cope with illness following a consultation. The results suggest older patients are not disadvantaged by telephone consultations. In fact allowing for greater disability and chronic illness among older patients there was no difference in PEI scores between groups older and younger than 70 years. However, a local evaluation at practices operating a variety of Advanced Access ideas suggests that such practices are experiencing a greater influx of ‘walk-in’ cases (17%) perhaps because getting through on the telephone is more difficult! Patients may be responding by presenting themselves in person making nonsense of efforts to contain workload.

Finally, health-care assistant facilitated, open access, 3-minute GP consultations have been trialed in a deprived inner city community in our region. An evaluation suggests that this innovation successfully resolved access problems and was seldom abused. Our impression is that Advanced Access is a complex intervention and in some practices, and for most patients, is viewed as an improvement.