Usually, when people think about accessing primary care services they tend to be thinking of calling the GP practice where they are registered, or queueing to speak to a receptionist, or maybe even using an app provided by their practice to book an appointment.
But that’s only part of the story. What about when it is the health service itself that is interested in getting you or someone you care for to attend an appointment. This might be to attend a health screening appointment, like the NHS Health Check, to book an immunisation, like those given during childhood or annually during flu season, or it might be to get you in to review a pre-existing condition that you manage. This is where call and recall comes in.
Call and recall, for the uninitiated, is the process used by most GP practices to encourage the public to book and attend an appointment that will help to protect their health. Usually, the practice has a stake in getting them to attend. This could be that the practice is required to report on these appointments, with performance data ranking practices and regions against their peers. Or it could be that a financial incentive is offered to the practice for delivering that kind of care. In most cases, practice staff are responsible for encouraging public participation and the call and recall process is the tool they turn to.
You yourself have been on the receiving end of call and recall if you have ever been sent a letter asking you to call the practice and book yourself in for a smear test, or received a phone call telling you it was time for a flu jab. Most practices use a combination of traditional letters, text messages and phone calls made by reception staff to encourage patients to book these appointments.
This distinction, between bookings that are initiated by the public and bookings that are initiated by the practice, might seem trivial – but it really isn’t.
When you answer the phone to a patient or speak to them across the desk, usually they are already motivated to access care. What’s more, we know that they are motivated enough to go to the trouble of queueing up at the practice, or trying to get through on the phone (which isn’t always an easy task – with 30% of the public expressing their frustration at being able to get through to their registered practice by phone). When you are trying to engage a member of the public, who may not know what it is you are trying to engage them in, often that motivation is missing, or it needs to be created for the member of the public to take up the appointment. Understandably, the member of the public will want to know why they should care.
Oftentimes, a completely different skillset and knowledge base are required to successfully carry out call and recall in a GP practice. You need to be able to build trust with the person you are communicating with, you need to fluently explain what and why this person is eligible for, and you need to be able to answer any questions they may have –all before getting to the booking part.
But one thing that most don’t realise is just how big the call and recall challenge is. The data on how many appointments require call and recall attention isn’t great – primary care data just isn’t labelled in that way – but the practice staff that we speak to estimate that 10% to 20% of appointments in their practices require outreach in one form or another. NHS Digital reporting shows that in 2019 there were 312 million appointments in primary care, which means 30-60 million appointments that could require call and recall activity. Even the lower, more conservative end of that estimate is greater than the total number of A&E attendances in the same year.
Now we begin to understand the scale of the challenge: each of the 6,990 GP practices in England, armed only with their call and recall processes, must help the general public to understand, accept, book and attend between 4,000 and 8,000 appointments a year.
But maybe you are left thinking “so what?”
Well, the reason that we should all care about this under-appreciated corner of primary care is that it is one of the few things that stands between us and an unsustainable NHS. The appointments that require call and recall overwhelmingly concern preventive and public health care programmes, which demonstrably reduce the burdens placed on the rest of the health service – including secondary and acute care. According to the Kings Fund, preventable ill health was responsible for 64 per cent of all outpatient appointments and over 70 per cent of all inpatient bed days in 2018, before COVID-19. Without robust call and recall processes, these programmes will struggle and the whole system will suffer as a result.