ADVICE LINES: Telephone advice systems can be a convenient and cost-effective way to communicate with patients.

The diabetes team at Leicester General Hospital, a 650-bed acute unit serving a multi-cultural population of a million people, has been grappling with increased demand for some years.

People with diabetes had said they wanted quick and easy access to support and advice. We were keen to provide this in an innovative way. The old system offered one answerphone facility for people with diabetes and only one direct telephone line, and users expressed dissatisfaction with this. There had been a lack of central investment in the telecommunications infrastructure within the hospital. Callers were often greeted with an engaged tone or an answerphone message during normal office hours.

We explored various options through clinical governance meetings, which also involved people with diabetes and the Leicester Diabetes UK Group.

Our goal was a personal, efficient and cost-effective system able to support a large number of patients.

After a trial period, Leicester Diabetes UK branch raised£5,500 to buy a call-centre system configured around automatic call distribution. This meant incoming telephone calls were handled in a structured way. Staff are supported by our 'realtime' computerised patient record system, called PROTOS, to ensure the advice given is appropriate.

It also records the consultation so that other team members know what has been going on.

Telephone headsets are used in order to comply with health and safety regulations. Our specialist nurse team's work patterns were adapted and a flexible working system introduced. Three shift patterns provide service cover, from 8am-7pm Mondays to Thursdays and 8am-5pm on Fridays.

We wanted to offer equality of access for all our patients, including those whose first language is not English. There is now enough telephone capacity to dedicate a direct line to this. Callers are advised to ring a separate number and can listen to a recorded message in a language understood by at least two of our biggest client groups - Gujarati and Punjabi.

Callers can leave a message on this phone, and the messages are translated at least once a day by our diabetes link worker. The team then calls the patients back with the language assistance of our interpreter.

We felt that primary care health professionals also want quick and direct access to the diabetes specialist team. The pooling of limited lines via our call centre enabled us to provide a separate and dedicated fax and message service to this group.

The service started in June 2000. In August the nursing and dietetic team received 234 phone calls from patients, and 1,051 outgoing calls were made in the same period. The average duration of incoming and outgoing calls was eight minutes. In September 256 calls were received and 1,211 calls made. The busiest time of the week for both months was Wednesdays, with Fridays and Mondays being the quietest. We are currently re-auditing this.

Providing patients with telephone follow-up can be an efficient way to provide support, in addition to face-to-face consultations and group education.

To see a GP for an eight-minute consultation costs about£3. 75, whereas calling a specialist nurse for the same duration would cost£1. 63. This does not include the indirect costs to patients and their families - for example, the time and cost of travelling to the GP or diabetes centre, or taking time off work.

The benefits of the call centre include:

ability to handle large volume of calls;

equal call distribution, fully optimising staff resources;

management opportunities to plan staff according to busy and quiet periods. For the future it could be used to train and evaluate quality of calls;

ability to track performance at all times, ensuring the required levels of service are maintained;

greater use of PROTOS using telephone headsets, making it easy to document each contact;

telephone line less frequently engaged;

option to leave messages on the voicemail of individual staff if and when required.

The nurses, supported by the diabetologists, provide a service over bank holidays. Nurses work on a rota system covering the bank holidays, but they do not need to be on site. The system can be configured so that messages left on a central voicemail box can be remotely accessed from home by the specialist nurse.

This system could also be used to extend our outof-hours provision of support as recommended by the Audit Commission, perhaps improving access with a freephone telephone number.

At present, such provision is patchy. Most nurses give their mobile telephone numbers to patients who they are aware are having difficulties This system improves the ability to communicate with patients. Diabetes teams should not be afraid to embrace new technology to improve care.