Patients who are living with more than one long-term health condition like diabetes, asthma or depression (multimorbidity), tend to report worse experiences of access to primary care, including telephone access. So the research team, consisting of Dr Katie Saunders and the Birmingham, RAND and Cambridge Rapid Evaluation Centre (BRACE), wanted to discover if the introduction of telephone triage had an impact on how quickly people with multimorbidity could speak to a healthcare professional, compared with people who did not have more than one healthcare condition.
Telephone triage has gradually appeared across the UK’s primary care system over the last decade, but in 2020 it was introduced rapidly in almost every GP practice, to limit risks associated with COVID-19.
In telephone triage, patients call their general practice to make an appointment and are told that a doctor or nurse will call them back. When the doctor or nurse calls back, they listen to the patient’s problem, ask questions and assess their condition. Depending on the telephone triage assessment, an urgent or routine appointment may then be set up (over the phone, online or face to face), or the doctor or nurse may resolve the concern during the call.
In this study the research team explored the inequalities impact of introducing telephone triage in 154 general practices in England, looking at primary care access for people with multiple long-term health conditions. They used data from the GP Patient Survey to explore the impact of the introduction of telephone triage on the time taken to see or speak to a GP before COVID-19. They also used a survey called Understanding Society that collected information about health service utilisation and long-term health conditions during 2020, after the onset of the pandemic.
Although people with multimorbidity have a greater need for primary care, we found that when a general practice switches to a telephone triage approach, the change has a similar impact for all the patients in that practice. In general, all patients are able to see or speak to a GP more quickly. We found no differential impact for patients with different numbers of long-term health conditions attending the same general practice. These data, building on previous research, suggest that when a primary care service innovation is implemented for all patients, inequalities are more likely to arise because of variability in implementation between practices, rather than for groups of patients within the same practice.Dr Katie Saunders, lead author, Primary Care Unit, University of Cambridge
The team also looked at the impact of telephone triage on other inequalities in the time taken to see or speak to a GP or other primary care professional. Dr Saunders said: “We looked at whether telephone triage affected people differently, depending on their age, ethnicity, deprivation, sexual orientation, sex, and whether or not someone is a caregiver. Just as with multimorbidity, we found that the differences between groups of patients were small in comparison with the overall difference when telephone triage is introduced.