Centre for Academic Primary Care

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Telephone

Before introducing more telephone consulting then you may wish to think about:

  • What exactly are you trying to achieve through using an alternative to a face-to-face consultation? 
  • Do patients get to choose whether they have a telephone or face-to-face consultation?
  • For what purposes are you using telephone consulting? Initial assessment or triage? Follow-up?
  • Will you offer booked telephone appointments? How long will patients have to wait for you to ring them back?
  • Will telephone consultations replace some face-to-face consultations or are they additional work?
  • What proportion of telephone consultations convert to face to face consultations. This proportion is crucial in terms of whether telephone consulting is efficient
  • Will greater availability of convenient and accessible telephone consultations lead to more patient contacts in total (‘supply induced demand’)?
  • How will you measure the impact of telephone consulting of patient access and GP workload?

Before introducing the telephone as an alternative to a face to face consultation then you may wish to think about the following:

The choice of type of an alternative to a face-to-face consultation is dependent on your rationale for using an alternative to a face-to-face consultation. Is it for convenience for patients, improved patient access or to manage demand? It is also dependent on ensuring that the alternative to a face-to-face consultation(s) you have decided to introduce are suitable for your practice and its demographics. More information on who it is for and why can be found here. 

Practice costs

  • What will be the initial financial outlay?
  • Do you have sufficient infrastructure?
  • Were you planning on using your existing facilities and if so are there enough phone lines both into and out of the practice?
  • Will the additional calls be costed?
  • Will you be utilising a commercial system?
  • Will the introduction require further staff training?
  • Will you require funding for informing patients of the changes?

Patient related 

  • Are there certain patient groups that will be disadvantaged? More information on who it is for can be found here. 
  • How will you inform patients of the changes? – Possible options are; letters to patients, flyers, banners in the practice, social media or word of mouth.
  • What do your patients feel about telephone consulting? – Speaking to local representatives is key, perhaps through a patient participation group.
  • Is it more convenient for the patient? Will the patient have a booked time slot? If the rationale is to improve patient access, how convenient is it to wait around to be available for a phone call for several hours?
  • If the aim is to improve patient access and convenience, does the patient choose the form of consultation they would like? Or is this imposed by the practice because the main aim is to control practice workload?

Benefits and Concerns

  • Are you anticipating that a telephone call will be shorter/quicker than a face to face consultation? – it is worth auditing how long phone calls take, and what proportion lead to a subsequent face-to-face consultation.
  • What might be lost? – Accurate history, non-verbal cues, patient/doctor relationship.
  • What might be gained? – Flexible working, more control over own workload, patients feeling more relaxed, greater continuity of care, accessing patients who are otherwise unable to attend the practice.
  • What will you do if the technology fails? – Produce detailed protocols for use
  • How will you include the contents of the consultation in the patient records – will all doctors record this as a telephone consultation. Do they understand the importance of this? Do they need training on how to change the consultation type in the records?
  • How will you ensure that this does not become additional or hidden work? – Ensure scheduling and recording of the alternative to a face-to-face consultation.
  • Are you going to replace face to face consultations with telephone consultations in the appointments book – which would be appropriate if the aim is to be more efficient without increasing workload. Or are you going to add telephone consultations on top of the same number of surgery consultations, which will increase work overall?

Safety and Security

  • Have you considered how you will ensure that patient confidentiality is maintained?
  • How will you ensure security of the patients’ details?
  • Are you able to clinically assess the patient? Do you have a practice policy on which types of patients or consultation are not appropriate for telephone consultation?

We have provided some useful guidance below:

A list of companies that offer support for telephone consultations can be found here:

It’s easier for us and much more time efficient to phone a patient and often more convenient for them as well.

GP1 from a semi-rural Practice F

Even though I’m talking to [name of GP] on the end of the phone, it’s still more impersonal than face-to-face obviously. Because what you’re lacking is that sort of physical interaction, the subliminal reading body language. But it serves a purpose.

Patient from inner city practice A

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