Total triage should not be ‘automatic default’ after pandemic, says RCGP

The RCGP has warned against retaining the ‘total triage’ model of general practice beyond the Covid-19 pandemic, arguing that it may ‘exacerbate health inequalities’.

In a report published today, the RCGP has asked the Government to invest £1bn in digital infrastructure for general practice by 2024, arguing that ‘the benefits of remote consultations where they add value should be harnessed’. However, it stressed that ‘face-to-face care must remain a core element of general practice’.

It comes as GPs have reacted to a Mail on Sunday campaign to get practices to see patients face to face ‘again’, amid ‘fears of patients only allowed phone or video calls with their doctor’.

The RCGP is calling on the Government to conduct a ‘comprehensive review’ of total triage ‘platforms and processes’ following their extensive use during the pandemic, and to develop ‘UK-wide principles’ for their safe and effective use following the pandemic.

The report said: ‘[W]hile the capabilities and digital tools to support triage should indeed be retained and further built upon, we are not convinced that the “total triage” model or digital-first triage platforms should be the automatic default for all practices once the need for social distancing has lifted.

‘Evaluation is needed to establish what “good” looks like for triage systems for both patients and staff, in order to capitalise on their potential. This must ensure that systems do not exacerbate health inequalities.’

It added that ‘[s]hared decision-making and patient-centred care principles, which sit at the heart of GP
care, should be central to any future patient screening and signposting systems’.

RCGP chair Professor Martin Marshall said total triage during the pandemic had been ‘necessary so that we could continue delivering general practice services to patients whilst maintaining infection control in surgeries and keeping people safe’.

But he added that remote working ‘has been challenging for many GPs, particularly when delivering care to patients with complex health needs’ and said there was ‘evidence to suggest triage results in an increase in consultation numbers and remote consultations can take longer’.

He concluded that after the pandemic, the RCGP does not want to see general practice ‘become a totally, or even mostly, remote service’. Instead it ‘needs to be down to individual GP practices to be able to decide how they deliver services, based on their knowledge of their patient population’.

The RCGP’s position statement comes as GPs have again had to defend themselves against media claims that patients are not being offered face-to-face appointments.

While at the peak of the pandemic the proportion of face-to-face appointments in general practice fell to 30%, it now stands at around half. And, last winter, health secretary Matt Hancock said that 55% would be the optimum figure.

Despite this, presenting eight case studies, the Mail on Sunday claimed on the weekend (9 May) that ‘nothing has changed’ with regards to patients only being ‘allowed phone or video calls with their doctors’.

The publication prompted an exasperated response from GPs on social media, with some saying it left them ‘ready to throw in the towel’.

Dr Dave Triska, a partner in Surrey, said: ‘The story broke me on a Sunday – I’d only just recovered from an absolutely exhausting week of managing patients both in person and remotely, for truly complex and difficult problems that needed our help.

‘It would be impossible now with what is being asked of GP to revert to face-to-face only – waits would stretch to months, all the while causing harm. It feels like a slap to have soldiered on propping up the NHS and then be hit with such appalling and misinformed coordinated attacks on general practice.

‘I notice that we’re once again individually responsible, whereas problems in secondary care continue to be nebulously ascribed to corporate entities and no such campaigns take place.’

Dr Mike Smith, a partner in Hertfordshire, said: ‘Actually, my day would less stressful in the old model. Of course, having more GPs, better public health investment and reduced bureaucracy would help this, but we’re playing the hand we’re dealt at the moment and under the circumstances doing pretty well.’

He added: ‘We’re all at breaking point, and soon the Mail on Sunday will have to find someone else to direct their ire at when all the GPs leave.’

Dr Selvaseelan Selvarajah, a partner in East London, said: ‘Patients who have a clinical need are seen face-to-face. At no point in our surgeries in East London have we stopped seeing patients face-to-face. Six-week baby checks; child immunisations and smear tests are also done face-to-face. The triage-first model is welcomed by many patients as it enables their queries to be responded to much earlier and conveniently.’