BACKGROUND: Nurse management of minor illness is a common method of demand management in primary care. Delegation of minor illness management to nurses may result in a change in patients' presenting problems and the consequent consulting behaviours of general practitioners (GPs). AIMS: To assess the impact of nurse telephone triage in primary care on the consulting behaviours of GPs. DESIGN OF STUDY: Survey of patient records. SETTING: Three primary care practice sites in York. METHOD: During randomly selected weeks, 1 month before and 6 months after the implementation of nurse telephone triage, we measured the number of presenting problems per patient and the following four consulting behaviours of doctors: the number of consultations during the 4 weeks before and after the index consultation, the number of prescribed items, the number of outside referrals, and the number of investigations. RESULTS: During standard management 1102 index consultations were identified, and during triage 1080 were identified. Patients seen by doctors in the triage system had significantly more presenting problems and received more consultations, prescriptions, and investigations. Numbers of referrals to secondary care were not different. CONCLUSIONS: Delegating the management of patients with minor illness to nurses in a telephone triage system may result in an overall increase in the number of presenting problems per patient, as well as changing GPs' consulting behaviours. Appointment systems may have to be adjusted to ensure patients receive more GP time. Further work on developing measures of complexity and controlled studies of the impact of new working arrangements on workload in primary care are required.
BACKGROUND: Nurse management of minor illness is a common method of demand management in primary care. Delegation of minor illness management to nurses may result in a change in patients' presenting problems and the consequent consulting behaviours of general practitioners (GPs). AIMS: To assess the impact of nurse telephone triage in primary care on the consulting behaviours of GPs. DESIGN OF STUDY: Survey of patient records. SETTING: Three primary care practice sites in York. METHOD: During randomly selected weeks, 1 month before and 6 months after the implementation of nurse telephone triage, we measured the number of presenting problems per patient and the following four consulting behaviours of doctors: the number of consultations during the 4 weeks before and after the index consultation, the number of prescribed items, the number of outside referrals, and the number of investigations. RESULTS: During standard management 1102 index consultations were identified, and during triage 1080 were identified. Patients seen by doctors in the triage system had significantly more presenting problems and received more consultations, prescriptions, and investigations. Numbers of referrals to secondary care were not different. CONCLUSIONS: Delegating the management of patients with minor illness to nurses in a telephone triage system may result in an overall increase in the number of presenting problems per patient, as well as changing GPs' consulting behaviours. Appointment systems may have to be adjusted to ensure patients receive more GP time. Further work on developing measures of complexity and controlled studies of the impact of new working arrangements on workload in primary care are required.