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Telephone first consultations in primary care

BMJ 2017; 358 doi: (Published 27 September 2017) Cite this as: BMJ 2017;358:j4345

Comments on facts stated in the editorial

GP Access Ltd supplied nearly half the practice identities to the study, all those we worked with on an "Intention To Treat" basis. We also supplied all the consultation data to the study, extracted from GP clinical systems (it did not come from both companies as the article suggests). We stated that the telephone consultation duration could only be supplied for a minority of these, and the rest was imputed.

The article states, "Commercial companies marketing these systems report large reductions in GP workload and impressive reductions in attendance at emergency departments and emergency admissions." We don’t. Although I wrote a paper showing 20% lower A&E in a small scale study, we could not reproduce that result on a larger scale and stopped making any such claim in 2013. Still today you can see that claim made on the Doctor First website along with one for £30k saving per GP per year. We have never made such a claim and it is unfair for the authors to imply equivalence to two unconnected companies.

The heading “Policy makers should reconsider their unequivocal support for these systems” is, I submit, misleading. No funds have been allocated to support these systems, in contrast to £45m allocated to online consultations (qv reported lack of benefit, BJGP

Failure to measure any change in efficiency, even to investigate the reasons for differences in outcomes, denies general practice significant potential benefit at a time when it is most in need.

Competing interests: Founder & Chief Executive, GP Access Ltd

10 November 2017
Harry J A Longman
GP Access Ltd