Telephone Triage: Look Who’s Talking
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Dr Toni Hazell
GP in Tottenham Dr Toni Hazell qualified from St. Mary’s Hospital Medical School and did her Vocational Training Scheme at Northwick Park Hospital. She is a GP in Tottenham and was instrumental in her practice’s move to full telephone triage 7 years before everyone else started doing it! Toni has a strong academic background and works for the Royal College of GPs as an eLearning fellow. She also writes continuous professional development programmes for a variety of organisations, is an appraiser and sits on the Local Medical Committee for Haringey East. When not at work, she is kept busy by her two young children; in the occasional moment of spare time, her hobbies include running and playing the piano.
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ack in 2013, our practice took a bold decision. Faced with a mismatch between supply and demand, we started triaging every request for a GP appointment. Anyone wanting to see a GP in person would speak to one on the phone first. I still remember my fears that the system would collapse by mid-morning on the first day, but on the whole it was a success. Patients liked being able to talk to us on the phone, we could signpost them to the most appropriate professional, and tests could be done before an appointment so that the patient needed to come in only once.
But what about vulnerabilities that are to do with the subject, not the patient? Talking about sexual health, mental health, contraception or the need for a termination is hard enough face to face and often worse over the phone. What if the GP calls when you’re on the bus or at work? Teenagers are worried about confidentiality within the confines of a consultation room; how much worse is it when Mum might overhear from the kitchen? And how embarrassing is it for some people to have to tell the receptionist what they are calling about?
Fast-forward 7 years and telephone triage is now the done thing for everyone, important for reducing footfall in the context of COVID-19. Tips and tricks for effective, safe triage are being shared widely, and I doubt that things will ever go back to how they were. With better text and video technology, phone triage is great for many, especially those who work. We must, however, be careful that no one gets left behind and put thought into some of the people who might, such as those who don’t have access to a mobile phone, don’t speak English, are frail, are deaf, are homeless or are vulnerable in some other way.
As doctors, we need to gatekeep without discouraging those with sensitive problems. It’s useful for reception to get a brief idea of what the problem is so I can work out the order in which to call people back – it’s never great to get to the last call on your list and find that they are vomiting blood or have central crushing chest pain when I’ve spent the last hour talking to people with ingrowing toenails. But it can’t be compulsory; every day I have some calls where the clinical details just say “personal”, and that’s fine. Most of those will be about sensitive subjects,
