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GP practices continue total triage to protect staff and patients


Exclusive GP practices are continuing to triage patients remotely against NHS England guidance to protect their staff and patients against Covid, Pulse has learned.

In May, NHS England said that practices must offer all patients face-to-face appointments if that is their preference, while receptions must be open for walk-ins.

But current IPC guidance states that in primary care settings ‘where possible and appropriate, services should utilise virtual consultation’.

And practices across the country – backed by GP leaders – are sticking to the total triage system beyond next week, when all legal coronavirus restictrions will be lifted in England.

Liverpool LMC medical director Dr Rob Barnett told Pulse that the LMC has always advised practices to continue triaging patients remotely to protect patients and staff – and will continue to do so after the 19 July unlocking.

He said: ‘We have been recommending all along that practices didn’t allow walk-ins and patients should be triaged prior to accessing the premises.

‘There were issues at one point with patients saying they’d done a lateral flow that was negative so why couldn’t they just come in.’

Dr Barnett added: ‘We had the LMC meeting [last week] and there was a discussion on what we should be doing post 19 July. There was a general feeling we should be maintaining our current strategy of mask-wearing, social distancing and triage. 

‘It was felt there was a difference between opening up shops, where people go when they’re well, and practice premises. We have had discussions with our director of public health and I’m hoping there will be general support from public health locally.’

Nottinghamshire LMC chief executive Michael Wright said that ‘a number of practices’ in his area are also closed to walk-in patients for safety reasons.

He said: ‘We already have a number of practices preventing people from walking in and with rising cases, despite the changes on 19 July, practices still have to safeguard patients and themselves. 

‘It’s already very mixed across our area and will no doubt continue to be so past 19 July unless firmer advice/guidance comes out nationally in the meantime.’

Mr Wright added that practices are contractually able to choose how best to ‘meet the reasonable needs of their patients’, including by limiting face-to-face contact.

He said: ‘We will defend any practices who decide to limit face-to-face entry as long as it’s clear how to access them, that they remain “open for business” and that clinical decision-making is at the forefront of how patients will be triaged and attended to.’

Essex LMC deputy chief executive Dr Vaiyapuri Raja added that total triage and other social distancing measures ‘should continue in general practice’.

He told Pulse: ‘We are in the middle of a third wave and all precautions should be taken to prevent the spread within the practices. 

‘Total triage of patients, wearing of masks/face coverings and social distancing measures should continue in general practice.’

Both LMCs and the BMA have advised practices that NHS England’s guidance has ‘no contractual force’, and the BMA has warned that many GP practices are ‘not yet safe’ for walk-in patients due to unsuitable reception areas.

GPs have also previously warned that many Covid-symptomatic patients are now attending face-to-face appointments having only had a negative rapid lateral flow test (LFT), putting GPs and staff at risk. 

It comes as NHS England has today told patients and staff they should continue to wear face masks and maintain social distancing in GP practices and other healthcare settings after Covid restrictions end in England on Monday.


Simon Ruffle 6 August, 2021 11:02 am

Let us forget about Covid for a moment. Hot stuffy waiting rooms always been a biological minefield for patients. In general we bring down sick people and routine patients who are all mixing in the same area; the pandemic has shown light onto this ridiculous situation. We are not shut, we are not closed, we are just practising differently. BMA, RCGP and the NHS bodies across the UK need to help bring patients with us. The message needs to be that we are creating a safer, more appropriate environment for the sick, elderly and vulnerable to be seen. Using total triage we had been able to thin out the number of people in the waiting room and also to stop queues forming for routine enquiries. We have also been able to speak to the more urgent cases sooner as we do not feel so pressured by numerous people waiting to see us. GPs must continue to tell the truth to patients that funding, numbers of GPs, increasing patient command and actual patient numbers has put such a strain on the service that traditional type general practice is not viable. I am a dinosaur and did not like total triage to begin with but now have seen the benefits and have adapted; we just need to help the public to adapt too. I doubt there is any political will to do this whilst populist politicians pretend that public services can provide what people want rather than what they need; champagne with lemonade taxes.

terry sullivan 6 August, 2021 12:56 pm

use the car park for all f2f?

A non 6 August, 2021 4:53 pm

Agree 100% with Simon Ruffle

Clive Morrison 7 August, 2021 11:32 am

If general practice allowed unrestricted F2F, then potentially F/T clinical staff could be encountering 3-4 patients over a week carrying covid (a lot higher if cases begin to exceed 60K a day). The problem then is, patients may then mistakenly put down the clinician they saw as a contact on the online NHS track and trace form, when they subsequently become symptomatic and have a positive covid test. The HCP will automatically get instructed to self isolate by computer generated alerts to work emails or phone numbers. This is no easy task to resolve and correct. You have to contact 119 but this can take a few days to up date the system.

Vinci Ho 7 August, 2021 11:39 am

Just to clarify the information on our Liverpool LMC meeting date Rob was referring to . It was 6/7/2021.
Obviously , it took some time before this article appears on here after his interview 😎

James Weems 8 August, 2021 7:53 am

Spot on Simon R

Dave Haddock 9 August, 2021 9:31 am

Locally it’s Practices continue triage to avoid seeing patients and brag to their mates about how the doors are still shut.

Hot Felon 9 August, 2021 6:25 pm

I am a GP who also works in urgent care.
Problem here is that there are an awful lot of very lazy GPs who use ‘total triage’ as an excuse to send everyone to hospital over the phone.
Much of this is completely inappropriate and when it is I send a letter to that GP stating so.
Urgent care departments are bursting at the seams with patients who should have been seen and sorted by their own GPs.
Covid 19 cannot be an indefinite excuse for laziness and poor care.
If they need to be seen f2f, SEE THEM.

Patrufini Duffy 9 August, 2021 10:40 pm

Free. Unlimited.
Disrespected and de-professionalised.

You weren’t winning pre-covid. See them all FF and you still won’t win again. They’ll want telephone as they can’t make it and are heading out the Cornwall for the weekend. It’s a merry-go-round. No one has stood up and recognised how you’ve kept this country somewhat together. They think you’re a gimmick. Learn from that. GPs are the experts of history taking, triage, continuity and remote consultation. PERIOD. The IT infrastructure is helping you deliver this and you down play the value of even speaking to you on a phone, like you have no idea what is going on or command of the situation or what the next test is. I don’t know why you keep hyper-analysing this, you belittle your ability and question what is a right or wrong method of consultation in a free unlimited system, which has set you up to fail in *any situation you work as the floodgates are open and hyper-individualism exists. They didn’t protect your back when colleagues died. And you still haven’t learnt for their sake. Your antibodies are waning and some of you are yet to realise you’re a helper, not a saviour. Get out of that mentality before it consumes your ego. I agree with Felon, call the patient in if you like and if you don’t need to, don’t. You’re the doctor. You’re the expert. You know what to do, not the manager. Do a thousand ultimate FF home visits, try it, and they still won’t be happy. Nor will your impervious employer care.

John Graham Munro 11 August, 2021 1:29 am

Spot on——Hot Felon and David Haddaok

Deborah Owers 11 August, 2021 7:19 pm

Spot on Patrufini Duffy and Simon Ruffle