Welcome to the ESTEEM study website

ESTEEM: 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 with usual care.

The study is a multi-centre trial in collaboration with the Universities of Bristol, Warwick and East Anglia with the work being co-ordinated by the Peninsula Medical School.

The study will find out how well GP-led and nurse-led triage systems work. It will consider what difference these systems make to general practice workload and cost, and to patient experience of care, patient safety and patient health. While a few studies have explored nurse-led triage systems, there has been much less research addressing the value of GP-led triage systems. The patients in our study will be those people who ask for same day appointments.

Study summary

What do we want to find out?

A growing workload and increasing demands on general practitioners suggest a need to explore news ways of providing care for patients. Recent examples introduced include NHS walk-in centres and the 24-hour telephone advice service NHS Direct. This study will explore another way of providing care for patients in general practice, namely ‘telephone triage'. It is called ‘triage' when GP receptionists, doctors or nurses make a decision about the healthcare that each patient needs by talking to them first on the telephone. In a nurse-led triage system, patients have telephone calls with nurses, and in GP-led triage systems, patients have telephone calls with GPs. The triage systems are being promoted by the Department of Health, but we don't know how well they work.

What will be the focus of our study?

The study will find out how well GP-led and nurse-led triage systems work. It will consider what difference these systems make to general practice workload and cost, and to patient experience of care, patient safety and patient health. While a few studies have explored nurse-led triage systems, there has been much less research addressing the value of GP-led triage systems. The patients in our study will be those people who ask for same day appointments.

How will we find out?

We will carry out a study in 42 GP practices in Devon, Norwich, Bristol and Warwick. We will ask GP practices to provide either nurse-led triage, GP-led triage, or treat patients in their usual way. All patients asking for same day appointments in those practices will be recruited to the study over a 5 week period. Information will be collected for these patients using practice and Primary Care Trust records. Postal questionnaires will be sent to patients asking them about their experience of care. We will also conduct interviews and focus groups with patients and healthcare staff to explore how convenient and acceptable people find these new systems.