Six years ago we were struggling with patient demand, as many practices are now, and we saw the potential of switching to a system that starts with clinical assessment of patients with new concerns on the phone in the first instance. I led the introduction of telephone triage at our practice after being convinced by the Cochrane evidence and by my own experience of out-of-hours care.
I remember being taught that 80% of diagnoses can be made on history alone, and not every patient needs a physical examination. For example, for sore throats, recurrent UTIs or chronic problems, phone advice is often all that is required, saving time for both doctor and patient. In just 40% of cases at my practice does the doctor or patient feel a face-to-face consultation is needed.
Triage helps us direct the patient to the most appropriate service – GP, A&E, minor injuries, health visitor, physio, GPSI or pharmacist. It helps us book a consultation that’s appropriate; for example, a patient with mental health issues might need 20-30 minutes rather than 10. We can also remind the patient to bring things such as a urine sample, or prepare work while waiting for the appointment, such as a HADS questionnaire or blood pressure reading from our automatic machine in reception.
Patients generally understand their illness, but not always its severity or urgency or who they should be seen by. Poor access to primary care increases pressure on A&E, but I struggle to think of anything GPs could do to have more of an impact on this than phone triage.
Triage is a big cultural and system change but none of our doctors would go back to the old system now. The system does not mean more work for GPs – in fact, some practices find they have needed less doctor time in the long run. Although the current calls for more GPs and more GP time are legitimate, what we really need is to work differently.
Dr Steven Laitner is a clinical adviser to Patient Access and a GP in St Albans