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

Richards, D.A, Godfrey, L., Tawfik, J., Ryan, M., Meakins, J., Dutton, E. and Miles, J. (2004) NHS Direct versus general practice based triage for same day appointments in primary care: cluster randomised controlled trial. BMJ, 329 (7469). pp. 774-777. ISSN 0959 - 8146

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To assess the relative effects on consultation workload and costs of off-site triage by NHS Direct for patients requesting same day appointments compared with usual on-site nurse telephone triage in general practice.


Cluster randomised controlled trial.


Three primary care sites in York, England.


4703 patients: 2452 with practice based triage, 2251 with NHS Direct triage. All consecutive patients making requests for same day appointments during study weeks were eligible for the trial.


Type of consultation after request for same day appointment (telephone, appointment, or visit); time taken for consultation; service use during the month after same day contact; costs of same day, follow up, and emergency care.


Patients in the NHS Direct group were less likely to have their call resolved by a nurse and were more likely to have an appointment with a general practitioner. Mean total time per patient in the NHS Direct group was 7.62 minutes longer than in the practice based group. Costs were greater in the NHS Direct group—£2.88 (£0.88 to £4.87) per patient triaged—as a result of the difference between the groups in proportions of patients at each final point contact after triage.


External management of requests for same day appointments by nurse telephone triage through NHS Direct is possible but comes at a higher cost than practice nurse delivered triage in primary care. If NHS Direct could achieve the same proportions of consultation types as practice based triage, costs would be comparable.

Item Type: Article
Institution: The University of York
Academic Units: The University of York > Health Sciences (York)
Depositing User: Repository Officer
Date Deposited: 13 Nov 2008 16:44
Last Modified: 14 Nov 2008 11:08
Published Version: http://dx.doi.org/10.1136/bmj.38226.605995.55
Status: Published
Publisher: BMJ Publishing
Refereed: Yes
Identification Number: 10.1136/bmj.38226.605995.55
URI: http://eprints.whiterose.ac.uk/id/eprint/4854

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