GP telephone consulting is not safe after all

Well I remember meeting Dr Phil Dommett four years ago and his emphatic assertion to me “This is safer medicine”.  One of the pioneers of the GP telephone led model, you can read his note here how at his practice they are honing each others’ skills.

It became clear to me as a non-clinician that the safety was not in the clinical technique of telephone consulting or triage, but in the system.  We then started counting the responses given on reception to patient requests for a GP, and at the current state n=34713, in 13% the patient is told “sorry, call another time”.  

The key elements of safety are:

  • receptionists don’t have to turn patients away
  • every request for medical help has a GP call, very soon
  • the GP has capacity to follow the call with a face to face as needed, normally same day

This is not to say that a telephone call on its own is safer than a face to face.  The judgment is made by the GP.  It’s fascinating to note before launch we ask the GP “Was the consultation appropriate?” and get 11% on average marked as  “face to face not needed”.  Immediately after launching the GP Access system that moves to 60%.

There are plenty of studies, a Cochrane review, the recent ESTEEM trial (not whole system) none of which say that safety is compromised by GP telephone consults.  We keep a collection of links on our research page.  Yet endlessly one of the objections GPs throw at us is, “It’s not safe, you can’t diagnose over the phone.”  Those are the ones you decide to bring in.

So why my heading?  It’s unsafe to talk about telephone consulting as a solution to the “crisis” in general practice we are continually told about.  The RCGP has just released a paper on access which begins by asserting “no one size fits all”.  With a less than half hearted reference to our work (under our old name 10 months out of date) it wanders through a selection of one off case studies.

It is easier and lazier to keep rattling the begging bowl than to make a proper study of what works.  Yet with 68 practices now launched, another two next Monday, we have ample evidence, quant and quali, of the sustainability, transferability, patient and economic benefits of the system.  They don’t want to know.

If I were a public health scientist saying “There’s no one-size-fits-all vaccination policy” I’d be out on my ear.

Harry Longman
Founder, Chief Executive
GP Access Ltd

PS  what keeps me going nonetheless is seeing again practices who are thriving with their new system.  One in London this week, 18% list growth in two years, with the same GP sessions, and taking on extra income generating work.  Another with a median response time of 12 minutes.  If you haven’t yet seen what a transformed practice is like the Bourne video is unmissable.

PPS  I don’t believe in “one size fits all” for ever, either.  I do believe in applying the best current knowledge to our greatest problems, while working on better knowledge, hence askmyGP.

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