No evidence to support claims that telephone consultations reduce GP workload or hospital referrals

September 27, 2017

Telephone consultations to determine whether a patient needs to see their GP face-to-face can deal with many problems, but a study led by researchers at the Cambridge Centre for Health Services Research (University of Cambridge and RAND Europe), found no evidence to support claims by companies offering to manage these services or by NHS England that the approach saves money or reduces the number of hospital referrals.

As UK general practices struggle with rising demand from patients, more work being transferred from secondary to primary care, and increasing difficulty in recruiting general practitioners, one proposed potential solution is a 'telephone first' approach, in which every patient asking to see a GP is initially phoned back by their doctor on the same day. At the end of this phone call the GP and the patient decide whether the problem needs a face-to-face consultation, or whether it has been satisfactorily resolved on the phone.

Two commercial companies provide similar types of management support for practices adopting the new approach, with claims that the approach dramatically reduces the need for face-to-face consultations, reduces workload stress for GPs and practice staff, increases continuity of care, reduces A&E attendance and emergency hospital admissions, and increases patient satisfaction.

Some of these claims are repeated in NHS England literature, including the assertion based on claims from one of the companies that practices using the approach have a 20% lower A&E usage and that "the model has demonstrated a cost saving of approximately £100k per practice through prevention of avoidable attendance and admissions to hospital". Several Clinical Commissioning Groups have subsequently paid for the management support required for the approach to be adopted by practices in their area.

The NIHR acknowledged the need for robust and independent evaluation of current services and therefore commissioned the team led by Martin Roland, Emeritus Professor of Health Services Research at the University of Cambridge. The results of the evaluation, which looked at data sources including GP and hospital records, patient surveys and economic analyses, are published today in The BMJ.

The study found that adoption of the 'telephone first' approach had a major effect on patterns of consultation: the number of telephone consultations increased 12-fold, and the number of face-to-face consultations fell by 38%.

However, the study found that the 'telephone first' approach was on average associated with increased overall GP workload; there was an overall increase of 8% in the mean time spent consulting by GPs, but this figure masks a wide variation between practices, with some practices experiencing a substantial reduction in workload and others a large increase.

Dr Jennifer Newbould from RAND Europe, part of the Cambridge Centre for Health Services Research, the study's first author, says: "There are some positives to a 'telephone first approach'; for example, we found clear evidence that a significant part of patient workload can be addressed through phone consultations. But we need to be careful about seeing this as a panacea: while this may increase a GP practice's control over day-to-day workload, it does not necessarily decrease the amount of time GPs spend consulting and may, in some cases, increase it."

The researchers found no evidence that the approach substantially reduced overall attendance at A&E departments or emergency hospital admissions: introduction of the 'telephone first' approach was followed by a small (2%) increase in hospital admissions, no initial change in A&E attendance, but a small (2% per year) decrease in the subsequent rate of rise of A&E attendance. However, far from reducing secondary care costs, they found overall secondary care costs increased slightly by £11,776 per 10,000 patients.

Professor Roland adds: "Importantly, we found no evidence to support claims made by one of the companies that support such services - claims that have been repeated by NHS England - that the approach would be substantially cost-saving or reduce hospital referrals. This has resulted in some Clinical Commissioning Groups across England buying their consultancy services based on unsubstantiated claims. The NHS must be careful to ensure that it bases its information and recommendation on robust evidence."
The study was funded by the National Institute for Health Research.

University of Cambridge

Related Hospital Admissions Articles from Brightsurf:

US hospital admissions for non-COVID-19 have only partially rebounded from initial decline
While declines in U.S. hospital admissions during the onset of COVID-19 has been well-documented, little is known about how admissions during the rebound varied by age, insurance coverage and socioeconomic groups.

US hospital admissions for stroke fell by almost a third during lockdown
Almost a third fewer cases of stroke and mini-stroke (TIA) were seen in US hospitals during the height of the COVID-19 pandemic between March and April this year compared to the same time in 2019, finds research published in the journal Stroke and Vascular Neurology.

Growing numbers of alcohol related hospital admissions linked to local spending cuts
A new study by King's College London has shown an association between increases in alcohol related hospital admissions and decreases in spending on alcohol services since they came under the responsibility of local authorities in 2012.

Secondary school admissions system is still a work in progress
A new study by Lancaster University Management School highlights important inequalities in access to chosen secondary schools in England with minority ethnic families 17% less likely to achieve their first choice school.

Repeat antibiotic prescribing linked to higher risk of hospital admissions
Epidemiologists at the University of Manchester have discovered an association between the number of prescriptions for antibiotics and a higher risk of hospital admissions.

Help with medication reduces hospital admissions in older patients -- study
People aged 65 years and over are less likely to be readmitted to hospital if they are given help with their medication for three months after discharge, new research from the University of Bradford has found.

Electric scooter injuries, hospital admissions in US
Electric scooters are increasingly used as fast and convenient transportation in the United States.

Deprivation strongly linked to hospital admissions
People who live in areas of higher than average deprivation are more likely to be admitted to hospital and to spend longer in hospital, according to new research from the University of Cambridge.

Air pollution linked to several new causes of hospital admissions
Short term exposure to fine particulate matter in the air (known as PM2.5) is associated with several newly identified causes of hospital admissions, even at levels below international air quality guidelines, finds a US study published by The BMJ today.

Air pollution linked with new causes of hospital admissions
Several diseases have been linked for the first time with exposure to short-term air pollution.

Read More: Hospital Admissions News and Hospital Admissions Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to