By Nick Bostock on the 26 March 2021 GPOnline
NHS systems will be expected to embed total triage in general practice beyond the COVID-19 pandemic, according to a health service strategy paper that also outlines plans for a ‘significant’ rise in online consultations.
The operational planning guidance document published by NHS England – which sets out priorities for the year ahead – makes clear that NHS systems will be expected to ‘support practices to increase significantly the use of online consultations, as part of embedding total triage’.
The document also suggests that NHS England believes some GP practices are not delivering face-to-face consultations – a suggestion that has been condemned previously by GPs as offensive, and which brought an apology from NHS England’s top GP late last year.
Total triage was adopted across general practice from March 2020 on the advice of NHS England as the pandemic forced practices to limit face-to-face consultations.
Total triage
NHS England defines it as a model in which ‘every patient contacting the practice first provides some information on the reasons for contact and is triaged before making an appointment’.
Despite the shift towards delivering more consultations remotely, GP practices have continued to deliver large numbers of face-to-face consultations, with RCGP surveillance data suggesting that around one in three appointments are currently face-to-face.
However, the NHS England strategy document calls for NHS systems to ‘support those practices where there are access challenges so that all practices are delivering appropriate pre-pandemic appointment levels’. It adds: ‘This includes all practices offering face-to-face consultations.’
Both the BMA and RCGP condemned a letter from NHS England last year that suggested practices were not delivering face-to-face care. The letter was briefed to the media before it arrived with practices – and triggered what GPs described as a ‘demoralising media onslaught’.
General practice
Wessex LMCs chief executive Dr Nigel Watson told GPonline practices were offering patients access to face-to-face care – and warned that long-term use of total triage would not be workable for all practices.
His comments come just days after RCGP chair Professor Martin Marshall said that although triage – and remote consultations – had a role to play in general practice beyond the COVID-19 pandemic, it must be for GP practices to decide locally what works for their patient population.
Dr Watson said: ‘This has to be the starting point for a discussion. Total triage is workable for some, but is not what everyone will want.
‘Some people find it time consuming doing total triage. General practice is not one model – it is a number of different models – and this is not going to be a case of one size fits all. ‘
Dr Marshall told GPonline earlier this week that given the workforce crisis in general practice, some form of digital triage in future may be essential to manage workload – but was clear that models needed more evaluation and that the right solution would vary for different practices serving different populations.
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