We write in response to the news that national arbiters for the GP contract are to rule on whether telephone reviews for patients with asthma count towards Quality and Outcome Framework targets.1 Not to allow this would be a major setback to those who are developing and implementing innovative service provision models, which aim to increase access and offer choice of routine care to patients with long-term illnesses. The decision by West Wiltshire, and Kennet and North Wiltshire Primary Care Trusts, not to allow telephone-based asthma reviews, may be charitably described as unnecessarily restrictive in their interpretation of the contract; although cynics may speculate that this is a cost-saving exercise in the aftermath of practices' unexpected ‘over performance’ in achieving quality targets.
Patients with long-term diseases do not have equal opportunities of access to care. As clinicians, we fix times and locations of interactions with patients that are strongly biased in our favour. Ministers have expressed concern about this and are calling for longer opening hours. Providing the choice of remote reviews for chronic disease is a more practical solution which, if used appropriately,2 can provide care that is effective, cost-effective and valued by patients.3 It is a perverse ruling that encourages practices to ‘exception report’ those patients unable or unwilling to attend face-to-face reviews, rather than encouraging clinicians to offer convenient remote consultations.
Studies have demonstrated improved access, in the context of asthma reviews in primary care,4–6 and we have strong theoretical grounds for believing that this benefit is also likely to be true for a range of other chronic disorders. Furthermore, the telephone is only one of a growing array of communication channels (email, SMS text messaging, etc) now available that can facilitate delivery of convenient and accessible care. A ‘ban’ on telephone consulting would be a retrograde step that could impact negatively on the use of these other communication modalities.
It is ultimately patients who will be the losers if the decision to disallow telephone consultations is upheld. Telephone reviews are now acknowledged by the British Thoracic Society/Scottish Intercollegiate Guideline Network asthma guidelines;7 they should similarly be embraced by the Quality and Outcomes Framework.
REFERENCES
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