Survey of the impact of nurse telephone triage on general practitioner activity.
BACKGROUND
Nurse management of minor illness is a common method of demand management in primary care. Delegation of minor illness management to nurses may result in a change in patients' presenting problems and the consequent consulting behaviours of general practitioners (GPs).


OBJECTIVE
To assess the impact of nurse telephone triage in primary care on the consulting behaviours of GPs.


METHODS
Survey of patient records.


METHODS
Three primary care practice sites in York.


METHODS
During randomly selected weeks, 1 month before and 6 months after the implementation of nurse telephone triage, we measured the number of presenting problems per patient and the following four consulting behaviours of doctors: the number of consultations during the 4 weeks before and after the index consultation, the number of prescribed items, the number of outside referrals, and the number of investigations.


RESULTS
During standard management 1102 index consultations were identified, and during triage 1080 were identified. Patients seen by doctors in the triage system had significantly more presenting problems and received more consultations, prescriptions, and investigations. Numbers of referrals to secondary care were not different.


CONCLUSIONS
Delegating the management of patients with minor illness to nurses in a telephone triage system may result in an overall increase in the number of presenting problems per patient, as well as changing GPs' consulting behaviours. Appointment systems may have to be adjusted to ensure patients receive more GP time. Further work on developing measures of complexity and controlled studies of the impact of new working arrangements on workload in primary care are required.
School of Nursing, Midwifery and Health Visiting, University of Manchester, Manchester.
David A
DA
Richards
Joan
J
Meakins
Lesley
L
Godfrey
Jane
J
Tawfik
Evelyn
E
Dutton
D000328:Adult; D005194:Family Practice / Q000379:methods*; D005260:Female; D019538:Health Care Surveys / Q000379:methods; D006801:Humans; D008297:Male; D009732:Nursing Care / Q000379:methods*; D012017:Referral and Consultation; D013689:Telephone; D014218:Triage / Q000379:methods*