Most practice nurses say triage adds to their workload and do not want ‘total triage’ to continue after the pandemic, a Nursing in Practice survey has revealed.
The poll of 87 nurses working in general practice, carried out between 28 May and 4 June, revealed 58% hoped ‘total triage’ or an equivalent would not continue after the Covid-19 crisis.
Many nurses surveyed (38%) said triaging had increased their workload by ‘a lot’ and 34% by ‘a little’, and some said it had led to patients being abusive.
The survey comes after NHS England last month instructed practices to offer patients face-to-face appointments if requested. In March last year, it had advised surgeries to implement a ‘total triage’ system, so every patient had to contact the surgery via phone or online before making an appointment.
A nurse practitioner based in Scotland explained in their response: ‘You are phoning [patients] and then bringing them in so double the time.’ Another, also in Scotland, agreed triage could result in ‘double work’ when having to triage patients and then see them face-to-face.
Several reported abusive or unhappy patients. For example, an ANP based in the North West said: ‘Patients are expecting a same day telephone response no matter what the problem so lots of calls being squeezed in.’
A nurse practitioner, also based in the North West, described triage as ‘working well until you run out of appointments then verbal abuse starts’, while another in the Midlands said patients have an ‘unrealistic understanding’ of how many problems can be managed in one call.
A practice nurse based in the South East said patients get ‘frustrated’ they must go through triage to access the GP. A nurse practitioner in the North West said patients ‘perceive triage as a barrier to getting the care they need’.
Although many respondents reported feeling comfortable carrying out triage, some called for more training. Clinicians told Nursing in Practice earlier this month more triage training was needed.
One practice nurse, based in the East of England, added: ‘I do feel training or refresher training (for those who have not undertaken for a while) should be available. I would feel more comfortable.’
However, nurses saw the benefit of some form of triage continuing. One nurse practitioner based in the West Midlands wrote ‘it works very well as there are good number of patients that do not need to be seen face-to-face.’ A GPN based in Scotland said triage gives the practice ‘greater flexibility’.
Twenty-two per cent of the respondents reported no impact of triage on their workload, while just 6% found it decreases their workload a lot.
The survey also revealed that a mixture of staff members carry out triage in most practices (45%), followed by GPs (30%), nurses (15%) and then receptionists (8%). Most use both online and telephone (51%) to carry out triage, while 46% use only telephone and 3% use only online.
In addition, it found not all practices had switched to a ‘total triage’ system throughout the pandemic. Thirty-seven per cent had switched ‘completely’ and 27 per cent ‘mostly’ – although 3% said their practice had not carried out ‘very much’ triage and 1% said their practice had not switched to ‘total triage’ at all.
Most (68%) also said a triage system was not in place in their practice before the Covid-19 pandemic, which echoes findings from a major survey, run by Nursing in Practice Cogora last year, that found many practices did not offer triage before the Covid-19 crisis.