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Impact of a telephone-first consultation system in general practice
  1. Diane Miller1,
  2. Angela M Loftus2,
  3. Peter J O'Boyle2,
  4. Martin McCloskey2,
  5. John O'Kelly2,
  6. Donna Mace2,
  7. Neil McKeon2,
  8. Sian-Lee Ewan2,
  9. Laura Moore2,
  10. Aine Abbott2,
  11. Shane Cunning2,
  12. Mark O McCarron3,
  13. Anthony M Paget4
  1. 1 Pharmacy and Medicines Management Centre, Antrim Hospital, Antrim, UK
  2. 2 General Practice, Aberfoyle Medical Practice, Derry, UK
  3. 3 Neurology, Altnagelvin Neurology Centre, Derry, UK
  4. 4 Medicine, Swansea University, Swansea, UK
  1. Correspondence to Dr Mark O McCarron, Neurology, Altnagelvin Neurology Centre, Derry BT47 6SB, UK; markmccarron{at}


Purpose of the study Increasing pressure on general practice prompts innovative change in service organisation. This study sought to evaluate the impact of introducing a telephone-first consultation system in a socioeconomically deprived population.

Study design An interrupted time series of preplanned outcomes for 2 years before and 1 year postintroduction of a telephone-first system was used to measure the volume and type of general practitioner (GP) consultations and the number of patients consulted per year. Emergency department (ED) and GP out-of-hours attendances, the number of outpatient referrals, and the number of requests for laboratory tests were measured as secondary outcomes.

Results The telephone-first system was associated with a 20% increase in total GP consultations (telephone and face-to-face, effect estimate at 12 months, p=0.001). Face-to-face consultations decreased by 39% (p<0.001), while telephone consultations increased by 131% (p<0.001). The volume of individual patient requests for a GP consultation and the number of treatment room nurse consultations did not change. Secondary outcome measures showed no change in hospital outpatient referrals, number of requests for laboratory tests, and ED or GP out-of-hours attendances.

Conclusions A telephone-first system in a deprived urban general practice can decrease delays to GP–patient contacts. The number of patients seeking a medical intervention did not differ irrespective of the consultation system used. The telephone-first system did not affect GP out-of-hours, laboratory investigations or secondary care contacts.

  • health services administration & management
  • organisation of health services
  • primary care

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  • Contributors DM planned the study, collated the data and wrote the first draft. AML helped plan the study and revised drafts of the paper. PJO, MM, JO, DM, NM, S-LE, LM and AA all collected data and reviewed earlier versions of the paper. SC coordinated collection and anonymisation of the data. MOM edited and submitted the paper. AMP helped plan the study and revised drafts of the paper.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Disclaimer Neither the funding body nor the commercial company had a role in data acquisition or writing of the report.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Swansea University.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.