GPs’ and staff views of a ‘telephone-first’ approach to demand management: qualitative study

Abstract

Background To better manage patient demand, some general practices have implemented a ‘telephone first’ approach in which all patients seeking a face-to-face appointment have to speak to a GP on the telephone first. Aim To understand the views of surgery staff of the ‘telephone first’ approach and to identify enablers and barriers to successful adoption of the approach. Design and setting Twelve general practices using the ‘telephone first’ approach and two practices which had tried the approach but reverted to their previous system. Method 53 qualitative interviews with GPs and practice staff. Results Staff in the majority of practices felt the approach an improvement on their previous system. However, all practices had experienced challenges, especially where the new system led to a major increase in demand for telephone consultations without capacity to meet that demand. Staff were also aware that the new system suited some patients better than others. Adoption of the ‘telephone first’ approach could be very stressful with a negative impact on morale – especially in interviews with the two practices that had tried but stopped the approach. Interviewees identified enablers and barriers to the successful adoption of a ‘telephone first’ approach in primary care. Enablers to successful adoption were; understanding demand, surgery staff as pivotal, making modifications to the approach and educating patients. Conclusion Practices considering adopting, or Clinical Commissioning Groups (CCGs) considering funding, a ‘telephone first’ approach should consider carefully a practice’s capacity and capability before starting such an approach.