Telephone conversations or ‘consultations’
A report published in The Lancet and reported on BBC News questions the effectiveness of telephone consultations in general practice today. In my experience telephone ‘conversations‘ as opposed to ‘telephone consultations’ can be a very useful way for a patient to get a quick answer to a minor problem with their health care. You may have a query about taking your tablets or a reoccurring ailment that simply needs a prescription. The call could be taken by a doctor, a practice nurse or a nurse practitioner and in the overall scheme of things can make the surgery day better organized.
The telephone conversation can save both the patient’s time and the doctor’s time. Many doctors now offer a call back service for minor problems but if you have a new problem not seen by the doctor before this is when the problems start and yes experience does show that a significant number of patients still need to physically see the doctor. This effectively means that there are two contacts are made instead of one costing both more in time and staff involvement. The problem as I see it is that patients do not and cannot be expected to know what is minor, what is major, what is urgent and what is non-urgent. Sometimes reception staff are given some guidelines on how to deal with calls but basically speaking to or seeing personally a health professional is the safest way forward.
Some practices have introduced a system of a doctor vetting all incoming calls requesting an appointment and claim success as a way of managing work. I have also experienced the reluctance of experienced doctors just to handle a patients health care on the telephone. Obviously there are enquiries from patients that suit the telephone conversation. But again there are situations where to just take a phone might result in a serious risk to the patient.
Out of Hours services and 111 depend greatly on the expertise of ‘staff’ to elicit enough information from a caller upon which to base an informed and considered decision. Perhaps video calls might be a solution. Access to a patients record might be another solution.
Overall the way in which a service is provided depends on time, the number of doctors, nurses and staff on duty, the number of telephone lines available and the funding to do it. I have always said that there are never no appointments but to provide an effective service needs manpower, resources and adequate funding.
Robert Campbell – Retired GP practice manager
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Robert runs a web site offering information, comment and advice for GP Practice Managers and their staff.