Letters

I was intrigued by your news focus ('IT looks like trouble', pages 13-14, 14 September) outlining Dr Lawrence Buckman's impressions of NHS Direct. His comments reveal a misunderstanding common among many professional colleagues about the art and science of telephone triage.

Analysis of doctors triaging on the telephone shows how inconsistent we are in deciding even such simple things as whether a patient requires a home visit. Using the telephone as a medium of communication requires sophisticated skills and tools, especially if they are to deliver high-quality and consistent outcomes for patients.

Dr Buckman, or any other GP on the telephone, will have good days and bad days and areas of knowledge that are very deep and those that are not so deep. His intuition in different areas of care, as with all of us, will be variable. Good telephone triage requires a very good support tool.

Put the tool together with a clinician who is highly skilled and experienced in the use of that tool and the triage outcomes will be more consistent and appropriate than those of the clinician working on their intuition. Nurses using the tool correctly triage more consistently than GPs have done in telephone consultations.

Patient satisfaction in dealing with NHS Direct is very high. In the North East we operate an integrated model of care in which we work extremely closely with our GP cooperative. NHS Direct can be a great adjunct to primary care and it is the tool for others to use to both help with demand management and deliver high-quality care. It is already good, but with the newly procured system - tailored exactly to our needs - it's going to be even better. The platform offers the opportunity to signpost patients to all areas of the NHS reliably and with the minimum of repetition or inappropriate referral. It will have a profound effect on the way the NHS evolves.

Concern from experienced clinicians like Dr Buckman will only be resolved as they begin to work with and shape NHS Direct development.

It is welcome, as is the willingness of clinicians generally, to see the enormous potential for a consistent NHS triage system to be the cornerstone of a truly integrated NHS.

Dr Kevin McKenna Medical director NHS Direct North East