Telephone first access to general practice for older people- a qualitative study

Abstract

Background: recent years have seen increasing pressure on primary care workforce and appointments, with ‘telephone first’ introduced in the UK to manage demand and workload. Patients discuss healthcare needs via telephone with a general practitioner (GP) before being invited to make an appointment.

Older people are at increased risk of inequality in accessing primary care appointments, with more long-term conditions and increased communication difficulties using telephone. These inequalities were potentially exacerbated during Covid-19.

Aims: this study aimed to explore experiences of older people, carers and general practice teams in using telephone first to access appointments.

Design & setting: qualitative study in primary care.

Method: we conducted 48 interviews with older people/carers, and six focus groups with staff from general practices using telephone first.

Results: practices and older patients had varied approaches to ‘telephone first.’ As well as adapting to the concept of triage call back, challenges for older people and their practices included changing their understanding of what constituted consultations. Trust between patients and their general practice influenced views and experiences, with acceptance of telephone first being linked to their overall trust in the general practice. We observed differing views on how telephone first worked between patients and general practices reflecting poor communication between the two groups.

Conclusion: systems implemented into practices need to be adequately explained regarding processes, staff roles and expectations of patients, to allow for thorough understanding, and a demystification of the unknown. Future research should examine how telephone first approaches affect older patients' health outcomes.

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Identifiers

ORCID for Helen Atherton: orcid.org/0000-0002-7072-1925

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