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No plans to move away from remote triage, says NHSE

No plans to move away from remote triage, says NHSE

General practices should continue to triage patients remotely and there are currently no plans for when the approach will end, NHS England has said.

GP leaders have also told Nursing in Practice sister title Pulse they believe the ‘total triage’ arrangements will continue ‘for some time’, perhaps even beyond the end of the pandemic, due to the expectation that social distancing measures will continue.

However, other GPs revealed practices have stopped offering total triage because of workload pressures and the approach ‘not saving any time for some clinicians’.

NHS England said remote triage should remain in place where possible – and that the contractual exception allowing practices to suspend online appointment bookings still stands.

An NHS England spokesperson told Pulse on background it cannot yet say how long these arrangements will continue to be in place but it is committed to ensuring patients retain the option to access services digitally going forward.

Practices should use remote consultations and offer patients video appointments when appropriate, while ensuring patients have clear information about how to access services, the spokesperson said.

Practices should restore activity to usual levels where clinically appropriate and proactively reach out to the clinically vulnerable and those whose care may have been delayed, they added.

It comes as NHS England operational guidance last month revealed plans for practices to ‘significantly increase’ the use of online consultations as part of ‘embedding total triage’ – first introduced at the start of the pandemic to reduce transmission of coronavirus.

BMA GP Committee deputy chair Dr Mark Sanford-Wood told Pulse that practices are likely to be ‘in the same scenario for quite a long time’.

He said: ‘The requirements for social distancing are probably going to continue for some time and really that’s where the total triage comes from. 

‘The indications are that’s not going to change very quickly very soon. I’m not aware that there’s any sort of timetable or plan for that.’

Essex LMC deputy chief executive Dr Vaiyapuri Raja added that he thinks remote triage is ‘here to stay’ because many practices have ‘seen a benefit’, with improved patient flow and ‘changed behaviour’ from patients.

He told Pulse: ‘Patients who need to be seen are seen face to face, practices never stopped, but what it has done now is streamline patients. 

‘It’s gone from “I want to see a GP or a clinician” to “you will see one if you need one” and that sort of change was really difficult to even contemplate prior to the pandemic.’ 

He added: ‘If we turned back to the old system we’d be back to square one where we could never meet the demand.

‘It’s a life-changing scenario in general practice really for us to be able to control demand and prove that patients actually do not need to see a GP and can see someone else.’

But for North Staffs LMC secretary and BMA GP Committee policy lead on NHS England Dr Chandra Kanneganti, the system is more mixed – with some local practices already ending total triage.

He said: ‘The majority have continued because it’s working very well for them and they said out of 10 patients you phone you’re only bringing in one, so the GPs actually wish to continue that.’

But for others, the system is creating more workload, he added.

He said: ‘Before it was only 10 minutes face to face and it was all done. Now I’m spending 15-20 minutes on the telephone and then bringing them in again for another 10 minutes face to face. 

‘That’s half an hour wasted – so it’s not saving any time for some clinicians.’

Total triage was adopted across general practice in March 2020 to limit face-to-face consultations, although practices – and particularly practice nurses – have still been seeing patients face-to-face.

GP access caused controversy in the autumn amid suggestions that practices were not ‘open’ and ‘GP-bashing’ in the media.

In September, NHS England landed itself in hot water with a previous ‘reminder’ to practices to offer face-to-face consultations despite the ongoing pandemic and its own ‘total triage’ advice.

The health secretary has previously indicated that GPs should continue current levels of remote consulting after the pandemic.

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