NHS Direct versus general practice based triage for same day appointments in primary care: cluster randomised...

Area of Science:

• Primary Care Management
• Health Services Research
• Nursing Practice

Background:

• General practices face increasing demand for same-day appointments.
• On-site nurse telephone triage is a common method for managing these requests.
• External triage services like NHS Direct offer an alternative model.

Purpose of the Study:

• To compare the impact of off-site NHS Direct triage versus on-site general practice triage on consultation workload and costs.
• To evaluate patient outcomes and resource utilization for same-day appointment requests.

Main Methods:

• A cluster randomised controlled trial was conducted across three primary care sites in York, England.
• 4703 patients requesting same-day appointments were allocated to either practice-based triage or NHS Direct triage.
• Key outcome measures included consultation type, duration, subsequent service use, and associated costs.

Main Results:

• Patients triaged by NHS Direct were less likely to have their calls resolved by a nurse and more likely to see a general practitioner.
• The NHS Direct group experienced an average of 7.62 minutes longer total consultation time per patient.
• Costs were higher in the NHS Direct group, averaging £2.88 more per triaged patient.

Conclusions:

• External nurse telephone triage via NHS Direct for same-day appointments is viable but incurs higher costs than in-house practice triage.
• Achieving similar consultation outcome proportions as practice-based triage could make NHS Direct costs comparable.
• Optimizing NHS Direct's triage process is key to cost-effectiveness in primary care.