Practice nurses need ongoing training to triage effectively or mistakes will be made, practitioners have warned.
Triaging by phone continues to be the dominant form of consultation at GP practices and is here to stay, clinicians have told Nursing in Practice.
But not all practice nurses have the necessary experience and training in triage to spot the ‘soft markers’ that could indicate serious conditions, practitioners have cautioned.
Many practices and staff had not triaged before the Covid-19 pandemic took hold in March last year and rapidly had to adjust to this way of working. In the early stages of the pandemic last year, NHS England advised GP surgeries to implement a ‘total triage’ system, so every patient had to contact the surgery by telephone or online before making an appointment.
Jenny Aston, an ANP for Granta Medical Practices, in Cambridge, said: ‘A lot of nurses are not used to telephone triage. I don’t think it’s safe for them do it unless they are highly experienced.’
She said that for nurses lacking experience in triage it was ‘all too easy’ to be led by what condition patients think they have, and that without the benefit of training they could miss ‘the subtleties’ of patient conversations, such as gaps in information.
Helen Lewis, an ANP in a practice based in Wales, which currently phone triages 50% of its patients, said training was key because even with experience, ‘it still takes a bit of time to get used to speaking to patients over the phone’.
Without the necessary knowledge and training, Ms Lewis said nurses could miss ‘the soft markers’ that signal more serious conditions, such as a patient with diarrhoea who could have food poisoning, but who, through careful questioning, also mentions there is bleeding, ‘which is a whole different pathway of care’.
Although triaging is supposed to be a way of helping surgeries cope with increasing workloads, Ms Lewis said triaging can also ‘add to your workload when a patient gives you a shopping list of problems over the phone’. Nurses need to know how to manage these conversations, she explained.
Ms Lewis said that with a potential workload ‘tsunami’ resulting from a backlog of patients, and people with long Covid, triaging is ‘crucial, and will be for a long time’.
Rhona Aikman, a practice nurse based in west Scotland where the consultation ratio is currently 85% phone triage and 15% face to face, said triaging was ‘a necessary evil’. ‘I would love to bring all our patients down to the practice, but it’s impossible to see everybody,’ she said.
Ms Aston said that with a ‘125% increase in workload’ her practice ‘does not have the capacity to go back to solely face-to-face appointments’.
Ms Lewis called for mandatory ‘ongoing triage training, like the basic life support training we get every year’.
To improve the triaging process, Ada Allen, an ANP at Arthington Medical Centre, Leeds, said there should also be ‘much more patient education that not all of their clinical problems require face-to-face presentation’.
Heather Randle, RCN professional lead for primary care, said: ‘Triaging and where appropriate treating patients on the phone, can play an important role and is a valuable option for those who may not always be able to go to the surgery.
‘It is vital, however, that nursing staff are given appropriate training to make sure all patients receive the care they need. If they have any concerns at all they should invite the patient to a face-to-face appointment or refer appropriately for further investigation.’
Angie Hack, assistant director of nursing programmes at the Queen’s Nursing Institute, said: ‘When triaging, GPNs need to have a sound knowledge base to be able to establish the seriousness and urgency of the situation and any potential risk to direct the patient to the appropriate clinician or service.
‘It is therefore essential that they have the right education, training and access to supporting resources.’
Nursing in Practice is currently running a survey to find out nurses’ views on triaging and face-to-face appointments. To take part click here.