Box 1.

Enablers and barriers to the successful adoption of a telephone first approach in primary care

Enablers

Barriers

Understanding demand: Understanding patterns of demand Matching capacity to demand Staff as pivotal: Reception staff well trained and supported Identified member of staff leading the approach GPs all using the approach consistently Making modifications to the approach: Making modifications to the approach to overcome challenges Confidence in using the approach flexibly Educating patients: Clear and updated guidance for patients about the telephone first approach

Insufficient capacity: Insufficient capacity to meet demand; for example, not enough GPs or reception staff to take calls Staff challenges: Reliance on locums and registrars not familiar with the approach Patient characteristics: Characteristics of the patient population that may make negotiating the system a challenge, for example, poor English, or unable to take calls at work Practical problems: Poor mobile coverage in the surrounding area