Total Triage

We wish to share some very exciting news about a significant change to our appointment system that will improve the way our surgery delivers care to all our patients.

GP practices across UK are moving to a ‘Modern General Practice’ model to make access to care and treatment easier for patients and help improve patient satisfaction. This is a national NHS project, and all general practices must adopt the system eventually.

From the 10^th of Feb 2025 we are going to trial Total Triage model before we adopt it with any adaptations to suit our own patient needs.

Please note this does not affect any nurse, pharmacist, or other supporting service appointment onsite. They all can be accessed as usual.

What is Total Triage?

Total triage is a General Practice workflow where every patient contacting a practice first provides some information on the reasons for contact and is triaged before making an appointment.

All patient requests will be triaged by one of our experienced GPs who will decide what the best course of action is. Where necessary, we might ask you to answer a few additional questions to help our doctor prioritise those patients who need more urgent care.

You could be given a face to face or telephone appointment; you could have a reply from the GP with self-care advice or you could be signposted to a more appropriate service.

We will have following types of appointments:

• Same day GP triage
• Same day face to face or telephone – for emergencies
• Within 7 days – for follow up with a healthcare professional if not urgent (You will receive a self-book link to book your appointment) if a GP feels it necessary
• More than 7 days – for routine planned appointments (You will receive a self-book link to book your appointment). Annual review or planned follow up requested by GP.
• Booking links for Nurse appointments – if a patient requires urgent bloods due to the presenting condition, GP/Clinicians we will see you the same day. However, if they require routine or non-urgent bloods, GPs/staff will send you a nurse booking link for you to manage alongside your diary and our availability.
• Care coordinator slots – for complex cases and pts requiring urgent support and are on GSF, safeguarding, Cancer and EOL register.

Please note Nurse appointments are not affected and remains the same as before if you need it for cervical screening, wound management, bloods etc.

The main purpose of the Total Triage model is to:

• enhance the quality of care our patients receive. 
• ensure they are given the most appropriate appointment or advice to meet their needs.
• communicate with patients in a timely way.
• Move away from first come first served approach to one based on patient needs.

 

How does it work?

All patients who ring the practice, complete e-consult or walk in to the practice will be assessed by reception team to do our best to get you to the right service in the first instance, with clinical triage being an option.

Ideally, practice could work better with patients submitting requests via e-consults, however we appreciate that this may not be possible for some patients. If you are unable to use or access the practice online form then please contact the surgery in the usual way and we will complete the request for you and add you to the triage list, if necessary,  to be reviewed by the GP.

After which the GP will review your request and you will either receive a call to be offered a same day appointment, receive a self-book link or you might receive a message with advice from the GP.

Please note that in order for the GP to triage your request in a timely manner it is very important to provide detailed and accurate information about your symptoms when you contact us in the first place. For example, if a patient has a cough, it would be much easier to triage the request with the following information: ‘I had a cough for 10 days. I have already used over the counter medicine, but it is not helping and in the last couple of days my cough has been worsening and it feels chestier. I also have a high temperature.’

If the information given is less detailed, such as ‘I had a cough for 10 days’, it makes it harder for the reception staff/GP to triage and we will need to request further information which could delay treatment.

The Total Triage service will be open Monday to Friday. During the weekend or bank holidays please continue to use the 111 service or call 999 for life threatening emergencies. Please note, there me be times when we may temporarily suspend the online triage form to help manage the demand. In these circumstances you will see the following:

• a message to advise that the Patient Triage is temporarily unavailable and information on when the link will be active again and how to contact the practice another way.
• a message prompting patient to use NHS 111 online, to find a local pharmacy or attend the Urgent Treatment Centre

How does this benefit you?

We know that change can be difficult sometimes, but we are confident that Total Triage will bring many benefits to our patients – for example:

• Total Triage has been shown to reduce waiting times and it enables us to attend to your medical needs more promptly.
• Using digital communication will mean that you can engage with us from the comfort of your home or workplace.
• Triage ensures that limited healthcare resources are allocated to patients who need them most urgently.
• Total Triage will address the increasing demand for appointments and reduce the frustration of having to call and be in a long queue at 8am.

If you have any questions or concerns our team is here to guide and support, you can contact the practice.

 

 

Why is the practice changing its appointment system?

The staff at Pinfold, along with NHS England (NHSE), have acknowledged the increasing demand for appointments and our capacity being unable to meet this demand. NHSE has recently published a paper (Delivery plan for recovering access to primary care) outlining their similar concerns.

There are not enough GP appointments nationally to meet increased patient demand so we are needing to ensure only those who need to see a GP will get an appointment. What a patient may ‘want’ is not the same as what they ‘need’.  Many conditions can be managed by non-GP clinicians – this includes physiotherapists, pharmacists, mental health workers, social prescribers, and other members of the team. 

The NHS system is complex to navigate, and we recognise patients need help with this.

Total Triage has been designed to ensure that patients who most need an appointment are able to get one, and to facilitate equity of access to care.

We understand how frustrating it can be for patients to wait in phone queues to get an appointment. We have also noticed that many patients are booking appointments that do not necessarily require one, and we are concerned that those who need to be seen are not getting seen at the right time.

NHSE has stated that there is good evidence that clinician triage and modern online tools make it easier to manage patient requests and involve the wider team, with higher patient satisfaction rates than with the more traditional model.

To address this issue, we are introducing a Total Triage Model of care. This means that anyone requesting an appointment or advice will have their request triaged. Our online consultation forms provide us with key information about your problem, so that we can arrange an appointment at the right time with the right person – if needed.

 

How do I access the practice services?

You can continue to access the practice service in your usual way, but we do know that when its busy some of you have to wait for several minutes on the phone or in front of the reception queue until you can get through. However, the practice would like to encourage everyone to start using the e-consult via our practice website to send your clinical complaints through.

• To make Patient Triage more efficient, we will be expanding the use of our existing online consult system ‘e-consult’. Our online consult system is accessible to everyone, with no need to download an app or log in. All you need is access to the internet, and you can access the system from any device, including your smartphone or tablet. Simply visit website to find the e-consult tab.

 

How will the practice respond?

• All calls will be received by reception and will try our best to get you to the right service in the first instance, including local services and clinical triage.
• We can arrange an appointment with one of our allied health professionals, such as our Nursing Team, Clinical Pharmacists, Social Prescriber, First Contact Musculoskeletal Specialists, or First Contact Mental Health Practitioner.
• Outcome of GP clinical triage, if an appointment is necessary, you will be sent an electronic link to make either a priority or routine GP appointment (depending upon the GP’s assessment of the urgency of your condition).
• Please be reassured that those with problems requiring a more urgent response will be identified by GPs, and contacted urgently, if an on the day appointment is needed.
• In some cases, we will be able to arrange necessary tests / investigations prior to your attendance, to maximise the value of your appointment.
• You may be directed to a Community Pharmacy.
• You may be given advice via text message or email.

 

What if I have trouble using the new system? 

• We hope to support patients and their families/carers to get used to the new way of contacting the practice and to become comfortable with this over time. 
• We will, of course, provide additional support to those patients who are unable to use online resources.  
• If you do not have on-line access, or experience other difficulties using digital technology, please speak to our patient services team about how we can help you in your usual way.

 

Do I have to share personal information with a receptionist if I ring/walk-in?

It is important you give us as much relevant information as possible so we can ensure your request is triaged properly.

We understand some issues can be sensitive and we can use a private room if needed.

Our Patient services team are trained in asking difficult questions, they have signed confidentiality documents and part of our team.  Their role is paramount to provide health services to our patients. 

 

Can I walk into the surgery to make an appointment?

• We strongly discourage patients from walking in to make an appointment.  Primary care has never been an emergency service – if a patient needs immediate medical attention, you should ring 111 or go direct to A+E.
• If a patient walks in, they will be treated the same as anyone sending an online consult or ringing the practice. The receptionist will ask you for details to care navigate you to the right service and will be add to the Triaging GP list to be assessed if right option.
• It does NOT speed up your enquiry – we manage the requests based on a safety system.

 

Do all appointments have to be booked this way?

• No, appointments for our nursing team are mainly managed over the phone.  This will be particularly relevant for annual reviews, blood tests, wound management.

 

Why can’t I just book an appointment like I used to?

• Nationally, GP capacity can no longer meet the demand and so we must put systems in place to ensure our patient gets the most appropriate safe care.
•  Health care is evolving, and we need to embrace this.

 

 

Isn’t this ageist?

• No – the majority of our more senior patients have access to the internet or smart phones and are quite capable of using the simple online system.
• We are planning to use our care co-ordinators at the practice to support anyone who needs a bit of extra help in the early days.

 

What about vulnerable patients or those with special needs?

• We work hard to identify our patients who may need extra help and can flag this on medical records ensuring the team are aware of any additional requirements. 
• If someone is struggling to navigate the system, we will support in any way we can.

 

What types of GP appointments are there?

• We have several different sorts of appointments which we can triage patients into. These include:
• Same day clinical GP triage
• Urgent – these tend to be ‘on the day’ telephone or face to face. These are shorter appointments to manage only 1 acute problem.
• Routine – these are for non-urgent problems.  Waiting times vary but are currently 2-5 weeks depending on individual GP availability. These are usually for planned annual reviews.
• Patient initiated follow ups – the GPs will send you a booking link, for telephone or face to face follow ups if a GP feels the needs for a follow up after your same day appointment. The link will encourage patients to attend or use the appointments if they still require to. This should reduce the number of missed appointments.
• Telephone slots – many things can be managed conveniently and safely over the phone. We will usually give a 2-hour window for this call.

• Care coordinator slots – for pts needing complex coordination, pts on GSF, cancer and EOL care urgently.

 

 

Who else might I be asked to see?

• Not every health problem needs a GP – over the last 5 years we have significantly expanded our team.
• Pharmacists – We have our own highly trained clinical pharmacists and technicians at the practice who manage all our blood pressure patient as well as complex medication issues.
• First Contact physiotherapists – our team see all muscular-skeletal problems. They will see and assess the problem and come up with a plan. This may include further tests; referrals and they link directly with the hospital.
• Mental Health Workers – we are lucky to have 2 experienced clinicians who see patients to assess and help manage most mental health conditions.
• Social prescribers – our team help patient where they may have a social problem or health problems linked with social situations. They can see patients and families at the practice or sometime at home.
• Nurses – our experienced nurse team manage many chronic and acute conditions.
• Community Pharmacies – a new program called ‘Pharmacy First’ has been set up to treat several minor conditions and they can prescribe antibiotics where appropriate.
• Community Eye service – most eye conditions are managed by this team, and they link in with local optometrists.
• Dentist – we are not able to manage any dental problems (even for emergencies) – if you don’t have your own dentist, please ring 111 for advice on accessing care.
• Self-care – many conditions can be managed with advice and support.
• Self-referral - to MSK, Podiatry, incontinence , community mental health alliance, smoking cessation etc.

 

Can I choose what time I come for an appointment?

• For routine planned appointments, we will give as much flexibility as possible (subject to availability).
• For urgent appointments, we expect patients to be flexible and will likely be asked to attend at any time between 8-6 subject to what we can offer.  We do NOT have flexibility on these.
• For urgent health problems, employers are legally expected to allow employees to attend these (including at short notice).

 

Why can’t I send a request when you are shut?

Primary care remains a Monday to Friday, 8-6pm service.  There are other services available for urgent problems outside of this time.

We have to manage demand on the practice – our practice team work hard but also need to work within safe working conditions.

 

What happens if you are full?

• We have carried out a lot of work looking at demand management and try to respond to predicted fluctuations in workflow.
• We have to remain safe – there has been a lot of concern about clinicians being overwhelmed by work stress and demand. This leads to sickness and reductions in service.
• There will be times when the work demand will exceed capacity, in this situation, you will need to contact 111 directly or contact us the next working day.

 

Can I choose which GP I want to manage my problem?

One of the questions asks if you have someone you would prefer to manage your condition.

It will depend on who is working that clinical day doing the triage and subject to appointment availability.

 

Will this help the telephone system?

• We recently upgraded our telephone system to include a call back service which has worked very well.
• We hope if more patients use the online system, it will significantly reduce waiting times on the phone for those who need to call for other reasons.