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



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.