The impact of telephone triage in primary care on inequalities experienced by people with multiple morbidities: a quantitative evaluation

Background Patients’ access to primary care in the NHS in England has in the past been predominantly via face to face consultations. Before 2020, there had been a gradual trend towards increased use of telephone consultations and telephone triage and then latterly also online consultations. However these gradual trends have undergone a step change as a consequence of the COVID-19 pandemic. The proportion of primary care consultations conducted by telephone was by mid-2020 greater than via any other route. Understanding the impact of telephone triage on inequalities in access to health care, particularly inequalities experienced by people living with multiple morbidities, contributes to the BRACE Centre’s overarching study of service innovations and their impact on people living with multiple long-term conditions. Understanding how the use of telephone triage, rather than the immediate booking of face to face consultations, might differentially affect the experience of diverse groups of patients, has become much more important since the onset of the COVID-19 pandemic with its consequent large increase in the proportion of primary care consultations (including triage) undertaken by telephone. Aims To evaluate potential inequalities in the impact of telephone triage ‘telefirst’ in primary care on the length of time taken to get to see or speak to a doctor or nurse among people living with multiple long-term conditions, when compared with other patients. Evaluation questions • RQ1: Considering only people living with multiple long-term health conditions, does a ‘telefirst’ service affect how quickly people can see or speak to an appropriate primary care professional? • RQ2: What is the size of that effect relative to the effect on people contacting a GP practice who do not have multiple long-term health conditions? • RQ3: Are there any subgroups of the population living with multiple long-term health conditions who are particularly affected (either positively or negatively) in terms of how quickly they see or speak to an appropriate primary care professional, both generally and when a ‘telefirst’ approach is used? Design and methods This study is a focused quantitative evaluation based on the secondary analysis of routinely collected survey data from primary care, supported and contextualised with a rapid literature and data review, plus stakeholder engagement and patient and public involvement (PPI) work throughout the project, particularly at the dissemination stage, to ensure that the results have a wide reach and impact. The analysis will explore, using data from the General Practice Patient Survey (GPPS), whether there is any differential impact of a GP practice switching to a telephone first approach, for people living with multiple long-term health conditions, in respect of their access to primary care. Dissemination and outputs Results from this evaluation project will be written up and shared widely in a number of forms, such as a short digital summary report and a blog, conference presentations, and will include PPI involvement, and the advice and contributions of the BRACE Centre Health and Care panel. The final report of this evaluation to the National Institute for Health Research (NIHR) will be submitted by 31 August 2021. This will include insights for future implementation, operation and development of telephone triage in primary care. Study timeline This is a rapid evaluation and the evidence review and data analysis will be carried out between January-March 2021, with the following three months used for analysis, testing of emerging themes, reporting, dissemination, and stakeholder engagement. Funding The BRACE Centre, including this evaluation, is funded by the NIHR Health Services and Delivery Research (HS&DR) programme (HSDR16/138/31).