CREDIT: This story was first seen in The Telegraph
NHS plans to force patients to have phone consultations with GPs will simply fuel more hospital admissions, instead of reducing pressures, a major study suggests.
The Telegraph reports that the research, by the University of Cambridge, shows that practices which insist on a phone conversation with a family doctor to decide who can gets an appointment have a greater workload – and higher hospital costs.
Health officials have said such schemes are key to reducing strain on health services, at a time of unprecedented demand.
But the study of 147 practices which introduced “telephone first” schemes found that in fact they saw a two per cent increase in hospital admissions along with a sharp increase in the amount of time GPs spent on consultations.
While the approach meant fewer face to face consultations in total, almost half of the patients who had a phone conversation still had to to be seen in person.
The combination of this and all the extra time on the phone meant overall, GPs spent around eight per cent more time in consultations, the research found.
The findings, published in the British Medical Journal, fly in the face of health officials’ claims by that the schemes could bring significant savings and reduce Accident & Emergency (A&E) usage by one fifth.
The savings from a two per cent drop in A&E attendances were dwarfed by rising costs from extra numbers being admitted to hospital, the new study found – amounting to almost £12,000 extra per 10,000 patients.
“There was no evidence to support claims that the approach would, on average, save costs or reduce use of secondary care,” researchers Dr Jennifer Newbould and Prof Martin Roland found.
The 147 practices who introduced “telephone first” were compared with a 10 per cent random sample of other practices.
In a linked editorial, Professor Brian McKinstry from the University of Edinburgh said policy makers and practices should think again, before enforcing such systems across the NHS.
“The study … should cause practices to think carefully about the wider, possibly unanticipated, consequences of a switch to a telephone first system and should lead policy makers to reconsider their unequivocal support for such systems,” he wrote.
While such consultations could work well for straightforward problems it was likely to increase workload and do nothing to address a mismatch between levels of demand and NHS resources, he said.
Patients had mixed experiences, with some finding the system quicker while others found it “frustrating”, with difficulties getting through or long waits for a call back, the reserach found.
The authors noted that NHS England has repeated claims that a telephone first approach can result in major savings.
The case is made in an NHS national review of urgent and emergency care, which in 2013 said such schemes are associated with 20 per cent less A&E usage, and cost savings of £100,000 per practice.
And in some surgeries, patients trying to see a GP are being screened by receptionists who have been given a half day course to become “care navigators”.
Surgery staff in London, Devon, Birmingham, East Lancashire, West Yorkshire, Tyne and Wear and Manchester are being taught how to direct patients to other health professionals, such as nurses and pharmacists, to reduce pressures on GPs.
Professor Helen Stokes-Lampard, chairwoman of the Royal College of GPs, said: “Telephone consultations can be convenient – and they certainly can help direct patients to the most appropriate care for their health needs – but as this research has shown they don’t necessarily reduce GP workload in the end as 10 minutes are 10 minutes whether spent speaking to patients over the phone or face-to-face.
“And, if as a result of the phone conversation, follow-up action is needed for that patient, then this actually may increase the GP’s workload,” she said, saying there was an urgent need to deliver promises to increase the number of GPs by 5,000.
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