A significant proportion of consultations might take place by phone

NHS Direct, the United Kingdom's open access telephone advice system, which is staffed by nurses supported by computer decision software, has been the subject of a long and often bitter debate. Is it value for money; is this system the most effective; how should it relate to other services; and what is its effect on them? But this concentration on one particular initiative ignores wider questions about telephone consultation in primary care. What is its role? Who should do it? What background and training do its providers need?

The telephone has been around for more than a century, but the literature on these questions is scanty. A recent Medline search on telephone consultation found only 77 references on its use in primary care over 35 years. Most of these references were reviews, commentaries, or case studies, with only a handful of controlled trials.

Just as the recent debate has centred on NHS Direct, so the literature focuses on use of the telephone out …