GP phone consults: change has simply happened

No strategic transformation programme, no project management office, no Director of Delivery and Engagement,  no #hashtag did it. But change has happened.

Four years ago when I started Dot Community Health they told me that consulting over the telephone was unsafe, impossible, immoral, uninsurable, and anyway they didn’t like it.  They had no time to make phone calls and the patients would abuse them.  Definitive proof: that GP who tried it and lost all her hair within a fortnight.

We don’t hear that now.

We hear, “Oh yes, we do a lot over the phone now, huge pressure, but it’s made a big difference, patients love it..  We wouldn’t go back.”

I could get upset that they are doing it on their own, but I’m not.  I’m upset that they are doing it so slowly, painfully, ignorantly and generally badly.  “We struggled for 6 months”.  “We had one duty doctor.  Now we have two.”.  “We only do it on Monday and Friday.”.  “We phone on the day stuff but routines are bookable 4 weeks in advance.”  Or simply  “Mondays are hell.”

All these gross errors are so easily corrected.  GPs make them by impeccable logic but ignore the evidence we have discovered and publicised over several years.

So over the next few weeks we are going to repackage and republish what we know to make a free resource for GPs to use.  It will pull no punches.  It will tell you the counterintuitive leaps you must make to save yourselves from needless pain.

You will need to unlearn in order to learn.  There will be no room for lazy thinking, and the first foolish notion to go is “No one size fits all”.  That oft-heard phrase actually means “we don’t have a clear idea of our purpose, we don’t understand outcomes, we have no measures, we’re the NHS so being nice but ineffective doesn’t matter.  It’s someone else’s money.”

Meanwhile, we have moved on.  Continuing the series of histories completed by patients online in their own time, I have a very unusual one for you.  Simon is a fit 52 year old who never wants to bother a doctor:  Chest pain, what would you do?

Busy Wednesday at work, he never phoned about this, carried on for a couple of days.  Perhaps if he’d been able to send something easily online, he would have been in touch sooner.

Looking forward to see how you vote.  The first week, most GPs decided to see the patient (back pain).  Last week, most decided to phone first (skin rash).  The key thing is, the triage decision took only seconds to make.

No one response fits all patients.  A good system responds appropriately  to the infinite variation of patient needs.


Dr Sara Cowell

PS Thanks to David Doherty @mHealthInsight for this YouTube, US doctors so love their IT.  Laugh.


One response to “GP phone consults: change has simply happened”

  1. Dr Sara Cowell says:

    Dr P Sandhu writes re the Chest Pain history: “CALL 999, could be ACS as the man 52, paramedics would be there in 7 to 8mts ,if i can reach him before that aspirin 300mg stat and GTN spray about 10 doses or so , relieve pain, do 12 lead resting ECG which i carry a small portable machine, rush him to Heart Centre IF YOU HAVE ONE MOSTLY TERTIARY UNITS NOT YOUR LOCAL DGH for Primary angioplasty IF YOU CAN. otherwise your local Secondary care would do”

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