Telephone triage for new GP consultations

We were interested to read Holt et al’s article¹ giving further evidence that telephone triage for patients requesting new consultations ‘... appears not to offer added efficiency in terms of resource than usual care.’

However, when writing that ‘triaged patients were, in fact, more likely to require further consultations ...’, they understate the adverse effects on patients.

Taking the patients’ perspective, the National Association for Patient Participation (NAPP) remains very cautious about such telephone triage. We have pointed out that GPs undertaking it leave patients suffering increased worry afterwards and a significantly increased use of GP out-of-hours services or A&E units.² The authors of the ESTEEM study³ subsequently quantified this: ‘a small increase in GP (6.6%; n = 5171) and nurse (5.7%; n = 5468) triage when compared with usual care (5.4%; n = 5572)’. We disagree that this increase is small and think this statistically significant: 22.2% more use of emergency and other unscheduled services, when compared with usual care is, particularly for patients, big.

Because forcing patients to seek more help afterwards is such a blunt outcome, we conclude that triaged patients are losing the subtler points of GP consulting provided in usual GP care. This 22% increased use of emergency services subsequently is so high that NAPP considers that telephone triage for requests for new consultations in general practice is not safe for patients.