Table 1 Macro level of context: discourses, policies in play during trial implementation

Trial protocol as discourse

Telephone triage as research priority. Standardised ‘fixed text’ stating requirements of trial participation, integrity to intervention/control arms and fidelity, inclusion/exclusion criteria, ethical procedures and data collection.

Wider cultural discourse of telephone triage being about managing demand for care

Implementation of telephone triage in each GP practice is set with an agenda to reduce workload on healthcare resources. Triage interactions are therefore set up to assess urgency.

Telephone triage involves risk-minimisation

Introduction of telephone triage to manage acute cases necessitates a risk-minimisation approach. CDSS designed with clinical algorithms to minimise risk of clinician reaching incorrect triage outcome.

Nurse status/role and responsibilities

Historical discourse of primary care nurses building ongoing empathic relationships with patients, responsible for face-to-face chronic illness reviews. Telephone triage reconfigures role to gatekeeper/assessor of urgency, communicating with patients remotely to manage acute cases.

Patient-centred discourse of consultations

Consultations should be orientated towards patient-agendas and patient needs. Practitioner-patient relationship key to meeting patient’s needs.