Phoning Your GP – the arguments
The arguments about GP practices using 084 telephone numbers continue unabated. The BBC Rip Off Britain programme claimed this week that despite ‘guidance’ issued by NHS England in 2010 over 260 practices still use an 084 number. Even though the Terms of Service for GPs has been amended to effectively ban the use of non-geographical numbers NHS England stills seems powerless to impose the Regulations.
The 084 number systems provided by such firms as Daisy Line formerly Surgery Line offer an income stream from calls made to a surgery in the form of a refund or discount. The income is supposed to be used to fund improvements in the surgery. I am for one never sure what evidence there is of such a reinvestment being made into a practice. Having said that the modem telephone systems can be very expensive to buy and install and even more expensive to lease the latter of which in my opinion is very unwise choice. These new systems provide automated answering systems and can deal with numerous lines.
In defence of GP practices, their telephone lines can be very busy and to use a telephone switchboard term can often be bust. This means that there are more incoming calls than the number of lines can cope with. This is the eternal question for any business but for a GP surgery patients need to be able to speak to the surgery promptly. No one can predict who is going to call and what it is about and there is nothing worse than being in a queue if you have an urgent problem. I called one surgery in West Yorkshire once and found myself 22nd in the queue. No joy there then! I have recently needed urgent attention during the day and found that the NHS service I was calling was a message service only and I had to wait another half hour to speak to a nurse. My family were caring for a dying man on palliative care. At night it is even worse as you need to explain your situation in considerable detail before action is taken. You might get a call back but the wait is just another stressor.
So it is a very difficult balance to get right. How many telephone lines does a surgery actually need. As as broad guide I could say one line per doctor in the surgery. However probably two lines needs to be barred from incoming calls so that doctors and staff can call out. One line needs to be reserved for incoming calls by the doctors when out on visits. The remaining lines would be available for incoming callers. The problem then is whether there are enough staff on duty to answer all incoming calls promptly. This varies according to the time of day, the day of the week and the time of year. The Tuesday following a bank holiday can be a nightmare. Not an easy judgement to make. In a practice of 15,000 patients. I had 6 lines in use with the capacity to use 10. All these lines cost money with line rentals and call charges. One surgery I know switched on extra lines at busy times and allocated an extra receptionist to take the calls.
This is where modern telephone systems with call answering and options for callers to place a call to a particular telephone come into their own. But the equipment costs a considerable amount of money. I could argue that GP practices are not funded for elaborate and modern phone systems and this is why GPs look for systems that have an element of self funding. Nevertheless incoming calls need to be answered promptly. Perhaps this is one of the pitfalls of merging into larger practices. For instance one switchboard system might in use covering three surgeries. There are options to make an appointment, ask for test results or request a visit. Rarely is there an option to order a prescription. Rarely is there an option to fax a request for a prescription. Again text messaging and email systems are in their infancy but these still need staff to review what’s coming in and such systems are not suitable for urgent calls. What is also lacking is an override for emergency calls. Usually the caller has to listen to all the options before finding out that the urgent/emergency option is the last one on the list.
One firm has encouraged a system of speaking to a doctor first but evidence suggests that a proportion of patients still need to be seen or seen later which simply increases the number of contacts. One practice I know has introduced a nurse practitioner supported by an on call doctor who works all day. The lead GP told me that there was a shortage of GPs and this was a viable option – it seems to work well. Another practice in a North Yorkshire seaside town offers an all day service from 8am to 8pm and this seems to fit the bill very well.
So all in all whilst I agree with those who want to ban 084 numbers that are partly paid for by callers, I agree that GP practices need to examine very carefully the type and level of telephone contact they provide in their practices. It needs to be funded adequately and NHS England need to look beyond just banning inappropriate phone systems. Gone are the days when a surgery had just one telephone and one line and no one answered the phone on a half day…….
Robert Campbell is a retired GP practice manager who has worked at five West Yorkshire practices and now runs a web site for practice staff.