The effectiveness and cost effectiveness of telephone triage of patients requesting same day consultations in general practice: a cluster randomised controlled trial comparing nurse-led and GP-led management systems. - The ESTEEM trial
Every day, thousands of people phone their GP practice asking for an appointment that same day, and a nurse or GP must decide who gets seen and how urgently. This trial directly tests which method of making that decision—GP-led telephone triage or nurse-led triage supported by a computer system—works better and costs less. The problem is that UK general practices are overwhelmed, and many already use some form of telephone triage without solid evidence that it is safe, effective, or good value for money. Previous studies were too small or lacked the computerised decision-support tools now being promoted by the NHS. This trial fills that gap by randomly assigning 42 practices across four regions to usual care, nurse-led triage, or GP-led triage, then comparing costs, workload, patient safety, health outcomes, and patient experience. If the research succeeds, it will give NHS commissioners and practice managers clear, robust evidence on which triage system to adopt. That could reduce pressure on GPs, lower costs, and ensure patients get the right care faster—without compromising safety. For patients, it means a more reliable and efficient route to same-day care, even if they never think about the triage system behind the phone call.
View original technical description
A growing workload and increasing demands on UK primary health care suggest a need to explore news ways of providing care for patients. This study will investigate the effectiveness of telephone triage as one method of primary care provision. Many practices currently operate GP or nurse-led triage systems of different types as a way of providing fast access to care for patients and in order to manage practice workload, despite uncertainty about the benefits and costs. UK based trials of primary care telephone consultation and triage to date have been conducted in relatively small populations and/or in limited numbers of practice settings, and without the use of computerised interactive decision support. Moreover, there is currently little robust evidence of the effectiveness of telephone triage for patients requesting same day consultations in the context of in-hours general practice. This important agenda will be addressed in a large scale pragmatic cluster randomised controlled trial of two forms of triage currently being promoted by the NHS for use in UK Primary Care. The trial will compare the clinical and cost effectiveness of GP-led telephone triage versus nurse-led computer-supported telephone triage for patients requesting same day consultations in primary care. The principal outcomes assessed will be cost, primary care workload, patient safety, patient health status and patient experience of care. A nested process evaluation will examine the acceptability of the systems to patients and practice staff. The research will be conducted in 42 GP practices from Devon, Warwick, Bristol and Southampton, with individual practices randomly allocated to usual care, nurse-led triage or GP-led triage arms.
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