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Face-to-face triage has saved us three hours of appointment time a day

Dr Umar Tahir explains how a rapid triage system has brought workload under control and saved his practice from employing another GP

GPs are under increasing pressure to extend appointment hours. But at our practice, we believe it’s more important to improve access in-hours. We’ve done this by developing a face-to-face GP rapid assessment system to save GP time and treat more patients.

What we did

Over a number of years, our practice list size had increased and was becoming unsustainable - two GPs were trying to deal with 50 patients each morning. Many of these patients didn’t actually need to see a GP that day. We were inundated with requests for Med 3s or letters, rather than with urgent medical issues. In October 2013, we started using our Quickdoc rapid GP triage system to reduce the length of our morning walk-in sessions.

Now, when patients come in to the surgery between 9am and 10am, they are put on a triage list. They are seen briefly by the triage GP, who gives them a slip to indicate how they should be treated. The GP may decide to put the patient onto a second list for a full consultation that day, which they can sit and wait for or come back in a few hours to attend. Or patients may be treated in another way - via a routine appointment, a telephone consultation or another service. Using this system, we can deal with more than 40 patients within an hour.

Challenges

Our reception staff were worried they would bear the brunt of any initial dissatisfaction with the new scheme, but we combated this by asking the triaging GP to make it clear to difficult patients that triage was a clinical decision rather than one made by reception staff.

Additionally, to make sure that patients weren’t confused about the system, we put up posters in the surgery and explained the new system during one-to-one consultations. Practices thinking of implementing a similar scheme should also consider posting details about the triage on the website.

We started off with two people triaging - one GP making notes and the other consulting - but stopped because it wasn’t saving any time. We instead made a template for the triage, which uses shortcut keys that make it easy for a solo GP to document the salient points of the consultation.

We also had to outline in practice meetings that triaging GPs must not give patients a proper consultation, even if the practice is short of GPs that day.

Results

The system has saved GPs up to three hours of appointment time per day. Most patients will be seen by the triage doctor within an hour and a half, whereas before they could have waited for up to four hours.

Without the new triage system, we would have needed to add several routine appointments to provide for our list size and employed another GP to work half a day, every day.

We measured patient satisfaction after putting the new triage system in place, and 71% of patients say they are happy to see a doctor sooner for a shorter appointment, rather waiting for a lengthier appointment they’re not sure they need.

Almost half of patients have used other NHS services as a result of the triage, such as the Pharmacy First minor ailment scheme and the ‘red eye’ service, which reflects how it has changed patient attitudes to accessing GP care and made them more aware of how to self-help.

And compared with telephone triage, seeing the patient in person feels like a much safer way to assess need.

Dr Umar Tahir is a GP at Manchester Medical.

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Readers' comments (13)

  • Just another queue for patients!

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  • ''Over a number of years, our practice list size had increased and was becoming unsustainable'' - So why did your surgery not employ more doctors if your list size has increased - if a surgery wants more profits - then obviously they have to introduce systems that suits them - but should not be advocating this as some innovative approach to addressing increase in the demand for patient appointments.

    The heading for this article should have said - ''Face to Face triage has increased our profits''

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  • Anonymous | Salaried GP | 27 March 2015 10:16am
    I'm afraid I disagree with you and the tone of your note. When the number of GPs who are willing to commit to practices is falling off a cliff in some areas, this is useful information for those who can't recruit. Funding for practices has fallen by 8% with an increase in costs of 22% over the last decade, against a doubling of the consultation rate, steps like this are also financially essential to survival. Anyone who thinks that the squeeze will disappear after the election is mad. The push for more efficient practice will only grow.

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  • Hmmmm, wonder how many med3 were handed out in 'consults' under 1min.....more motorways = more traffic.

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  • Really important information missing - What is the list size? Is this the Mancherster Medical in Moss Side Health Centre with a list size of 2,400? If so, might be feasible in smaller setting, but not a larger busy London practice. I like creativity though.

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  • Interesting approach, although probably a bit inconvenient for patients (maybe that's the plan!) but I wonder how telephone triage using the same system would compare to the face-to-face triage you're currently doing?

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  • Well done for trying something different. That's how GPs have survived so far by being adaptable not malleable.

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  • How many GP's does each practice need?
    I wonder if there is great variation between practice populations. Let's compare notes. I took the decision a few years ago to reduce my workload to a manageable level to protect my health. I knew that it would hit my profits but accepted that. I have a list of just under 5000 and in total we have 2.5 FTE GPs plus a GP registrar. 13 min appointments and availability within a couple of days. No emergency extras. I reckon that's an average of 1650 patients per GP. How does that compare to those practices who feel their workload is unsustainable? Profits still fair due to high QOF and enhanced services income, and no use of locums.
    Clearly this tactic doesn't apply if you cannot recruit.

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  • I like the pro active approach. But I came into GP to be a quality not Tesco quantity GP. You should think of a 'four hour' wait time as impecable for a sore throat, bloated stomach or itchy ear. Being a quickdoc maybe your practice's style but this will fuel your work load eventually and risk. GP list sizes nicely come full circle.

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  • I feel this practice has innovative ideas as to how to deal with extra demands which are non urgent but clogging the system affecting daily time management.
    I have done tel triage every Thursday for Friday appointments and to my surprise my following day's booked appointments have been reduced by 40%. This in turn has given me 40 % slots for Friday and t can manage my time efficiently.In this new NHS with increasing demands and decreasing resources we need to use all means to reduce pressures and get along with life.

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