Scott Wilkes: Sunderland’s got talentBMJ 2019; 364 doi: https://doi.org/10.1136/bmj.l95 (Published 16 January 2019) Cite this as: BMJ 2019;364:l95
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I was astonished to read that Scott Wilkes’ (BMJ confidential ‘Sunderland’s got talent’) single most important change to the NHS is to halt the ‘Doctor First’ telephone triage system. It would seem that since his stroke he has not had any need to call his personal GP surgery when under any stress or limited by time constraints.
I trained as a GP in 1991. Until the introduction of the Doctor first triage system, the universal complaint of patients, and my inevitable first–hand experience as a 'frequent-user' patient myself was that it was a myth that you could get through for an appointment when the phone lines opened. Anyone trying it will tell you that you have to sit on the phone waiting to get through for maybe an hour, if its not engaged, whilst receptionists battle with finding a suitable, or any, appointment. If you didn’t ring then, all the appointments would be gone for the day. Frequently patients were told that they might get on the urgent surgery list if they rang in first thing in the morning, only to face this wait. If you have a crying baby, are trying to continue to work, are elderly and unfamiliar with phones and or psychologically distressed this is an added burden.
For me, as a patient, that is in the past. My innovative practice has adopted the doctor triage system. It has transformed access. One can get through immediately and get help whenever the surgery is open. Minor things are dealt with straight away. Combined with electronic prescribing, straight to your local pharmacy, one doesn’t need to get to the surgery. It is a major win for patients. If needed, you will be seen. It is a well-recognised that the more senior the person undertaking the triage, the more efficient it is. Doctors are best placed to do it in General Practice.
Recently an elderly, acutely depressed friend was in tears trying to access another GP practice: having no mobile, the phone in the cold hall, not knowing if they would get through and urgently needing an appointment.
Please, Dr Wilkes, whilst aspiring to the ideal, consider the real world, where patients are vulnerable and desperate, and GPs are a limited and ever diminishing resource and find a different most important 'single change' to the NHS from the vast choice available.
Competing interests: No competing interests