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Primary Care

NHS Direct versus general practice based triage for same day appointments in primary care: cluster randomised controlled trial

BMJ 2004; 329 doi: https://doi.org/10.1136/bmj.38226.605995.55 (Published 30 September 2004) Cite this as: BMJ 2004;329:774
  1. David A Richards, professor of mental health (dr17{at}york.ac.uk)1,
  2. Lesley Godfrey, general practitioner2,
  3. Jane Tawfik, nursing team leader2,
  4. Mike Ryan, deputy director nursing services3,
  5. Joan Meakins, general practitioner2,
  6. Evelyn Dutton, research administrator2,
  7. Jeremy Miles, lecturer in biostatistics1
  1. 1 Department of Health Sciences, University of York, Heslington, York YO10 5DD
  2. 2 Priory Medical Centre, Cornlands Road, Acomb, York YO24 3WX
  3. 3 Tees East and North Yorkshire Ambulance Service, TENYAS NHS Direct, Willerby, Hull HU10 6HD
  1. Correspondence to: D A Richards
  • Accepted 12 August 2004

Abstract

Objective To assess the relative effects on consultation workload and costs of off-site triage by NHS Direct for patients requesting same day appointments compared with usual on-site nurse telephone triage in general practice.

Design Cluster randomised controlled trial.

Setting Three primary care sites in York, England.

Participants 4703 patients: 2452 with practice based triage, 2251 with NHS Direct triage. All consecutive patients making requests for same day appointments during study weeks were eligible for the trial.

Main outcome measures Type of consultation after request for same day appointment (telephone, appointment, or visit); time taken for consultation; service use during the month after same day contact; costs of same day, follow up, and emergency care.

Results Patients in the NHS Direct group were less likely to have their call resolved by a nurse and were more likely to have an appointment with a general practitioner. Mean total time per patient in the NHS Direct group was 7.62 minutes longer than in the practice based group. Costs were greater in the NHS Direct group—£2.88 (£0.88 to £4.87) per patient triaged—as a result of the difference between the groups in proportions of patients at each final point contact after triage.

Conclusions External management of requests for same day appointments by nurse telephone triage through NHS Direct is possible but comes at a higher cost than practice nurse delivered triage in primary care. If NHS Direct could achieve the same proportions of consultation types as practice based triage, costs would be comparable.

Footnotes

  • We thank the patients, nurses, nurse advisers, doctors, and receptionists who took part in this study; Martin Bland, Malcolm Campbell, and Gerry Richardson, who provided advice on statistical and economic analysis; Katrina Sayer, James Irvine, and James Gallagher, who entered data; Margaret Moore, who provided information technology support; Dave Cox, David Johnson, Robin Pearson, Gary Vale, and Clare Ward from Tees East and North Yorkshire Ambulance Service NHS Direct and Jayne Barnes, Anne Cooper, Hazel Penny, and Keeley Townend from West Yorkshire Metropolitan Ambulance Service NHS Direct, all of whom provided professional, logistical, and managerial support during the research.

  • Contributors LG, JM, DAR, MR, and JT initiated the study. DAR developed the methods, and DAR, LG, JM, JT, and ED further developed the methods and data collection instruments. ED collected and managed the data. DAR and JM analysed the data. All authors helped to write the research report. DAR is the guarantor.

  • Funding The research was supported by a grant from the Department of Health's Central NHS Direct Management Team. All researchers were financed independently from the funder.

  • Competing interests None declared.

  • Ethical approval The local research ethics committee gave ethical approval.

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