Telephone-first access to general practice for older people: a qualitative study

Recent years have seen increasing pressure on primary care workforce and appointments, with telephone-first introduced in the UK to manage demand and workload. Patients discuss healthcare needs via telephone with a GP before being invited to make an appointment.Older people are at increased risk of inequality in accessing primary care appointments, with more long-term conditions and increased communication difficulties using telephone. These inequalities were potentially exacerbated during the COVID-19 pandemic.

This study aimed to explore experiences of older people, carers, and general practice teams in using telephone-first to access appointments.

Qualitative study in primary care.

We conducted 48 interviews with older people or their carers and six focus groups with staff from general practices using telephone-first.

Practices and older patients had varied approaches to telephone-first. As well as adapting to the concept of triage call-back, challenges for older people and their practices included changing their understanding of what constituted consultations. Trust between patients and their general practice influenced views and experiences, with acceptance of telephone-first being linked to their overall trust in the general practice. We observed differing views on how telephone-first worked between patients and general practices reflecting poor communication between the two groups.

Systems implemented into practices need to be adequately explained, regarding processes, staff roles, and expectations of patients, to allow for thorough understanding and a demystification of the unknown. Future research should examine how telephone-first approaches affect older patients' health outcomes.