‘Relentless’ triage model contributes to GP workforce problems, say researchers

Policymakers should rethink the ‘relentless triage’ model of modern general practice as it is contributing to workforce problems, researchers have argued.

In a new review of 190 studies, published on the British Journal of General Practice, they said that ‘it is not inevitable’ that modern general practice must involve ‘relentless triage’ at the expense of ‘meaningful patient care’.

They also found that technology ‘does not inherently improve efficiency’ in managing the complex, undifferentiated workload typical of general practice.

The review aimed at reconceptualising the nature of current GP workforce problems, with the authors arguing that instead of ‘expanding access’ or incorporating additional triage, the NHS ‘should prioritise GP-patient connection’ to retain workforce.

A total of 190 documents published between 2013 and 2025 were identified for inclusion in the review, comprising 122 published research articles, three conference abstracts, and 65 other sources (such as policy reports, guidance articles, editorials, and books).

The researchers also highlighted that ‘chronic underinvestment’ in general practice has led to ‘overwhelming workloads’ and understaffing, negatively affecting workforce morale, particularly in areas of socioeconomic deprivation.

It also said that routine triage of patients with less complex cases to other team members may ‘inadvertently have an impact on workforce sustainability’ by tipping the balance towards GPs predominantly managing complex, uncertain, or emotionally demanding presentations.

It said: ‘It is not inevitable that modern general practice must involve impersonal patient interactions, excessive documentation, and relentless triage at the expense of meaningful patient care.

‘The current study’s findings reconceptualise the nature of current “GP workforce problems”.

‘Rather than simply expanding access to any practitioner or incorporating additional triage and indirect supervision, the authors of the current study argue that system designs should prioritise GP–patient connection, which is essential for navigating risk, managing ambiguity, and delivering equitable care.’

The review also demonstrated how the ‘commodification of care’ can affect GP–patient interactions, often ‘prioritising short-term financial objectives’ over ‘meaningful discussions’ or spontaneous engagement.

It added: ‘When systems become depersonalised, for example, by prioritising the speed of triage/access, relational dynamics may be disrupted. Patients may be (re)positioned as consumers and experience reduced personal connections with their GP or practice.

‘This erosion of relationship-based care reduces opportunities for GPs to engage in “holding work” that encompasses the emotional, relational, and advocacy labour involved in navigating uncertainty, providing continuity, and supporting patients in managing concerns over time.

‘Sustaining this intensity of work is incompatible with the constraints of the current 10-min
appointment model and necessitates a fundamental redesign of consultation structures and workload planning.’

The authors concluded that future policies ‘should prioritise personalised care’ and protect GP autonomy on how to deliver it.

It comes as GP practices are now contractually required to keep online systems open for patient requests between 8am and 6.30pm for routine enquiries regardless of capacity.

Last month, researchers argued that Government-imposed policies on online GP access and the effort needed to keep systems working are taking staff away from work that would be ‘more effective’.