Telephone triage by nurses in primary care: what is it for and what are the consequences likely to be?
OBJECTIVE
To examine the perceptions that those working in primary care have about the purpose and impact that telephone triage by nurses may have on their clinical roles and identities.


METHODS
Twenty-six semi-structured interviews were carried out with general practitioners (GPs), practice nurses and practice managers from a purposive sample of nine practices in one health district in the North West of England. Analysis drew on the techniques of constant comparison and discourse analysis.


RESULTS
Four themes emerged from the data: justifying triage - the respondents justify the introduction of telephone triage by emphasising the managerial benefits of controlling access and by suggesting the benefits this may bring to the patient-clinician relationship; categorising patients - patients are categorised and allocated on the basis of their biomedical diagnoses to the nurses or GPs in the practice; changing roles and identities - the hierarchy of patients and conditions created by allocating patients in this way strengthens and extends the professional hierarchy within a practice; and achieving a balance between conflicting aims - there is tension between the managerial need to triage patients according to their biomedical diagnosis and the aspirations that health care professionals have to personal and patient-centred care.


CONCLUSIONS
Telephone triage by nurses may be effective at managing patient access to GPs but the need to categorise patients according to biomedical and managerial criteria needs to be balanced against the professional roles and identities that those working in general practice aspire to.
Charles-Jones
Huw
H
School of Primary Care, University of Manchester, UK.
May
Carl
C
Latimer
Joanna
J
Roland
Martin
M
D001071:Appointments and Schedules; D001291:Attitude of Health Personnel; D004739:England; D005194:Family Practice / Q000458:organization & administration*; D006302:Health Services Research; D006801:Humans; D007407:Interviews as Topic; D024802:Nurse's Role; D009723:Nurse-Patient Relations; D009818:Office Nursing / Q000458:organization & administration*; D009936:Organizational Innovation; D018802:Patient-Centered Care; D011320:Primary Health Care / Q000458:organization & administration*; D019114:Remote Consultation; D013689:Telephone; D014218:Triage / Q000379:methods*; D016526:Workload