Total Triage Blog: What to think about when thinking about your model.

This is part of our blog series: “what we learned from implementing a ‘total triage’ system”.

PCS|Practices have started to go live with total triage. We aren’t the first in the City and we definitely aren’t the experts, but we know a few practices are waiting to hear how we are doing. Based upon this we are going to include a regular blog, which is neutral on system and process but may help others from our learning along the way. If any practices who are already live wish to share their learning too, that would be amazing please email pcs.enquiries@nhs.net.

READ BLOG 2 – Timelines/Project Plans for Go-Live


What to think about when thinking about your model

Our first blog edition includes what to think about when deciding upon your model and we’ve also included an excel document which may help you think about demand and the triage capacity needed. If anyone is on the journey the ICB is also offering funding and so the details and the application form are also included below for information purposes.

What do you want to achieve?

When deciding what and how to run a triage system consider what is important to you and your patients. We undertook an equality and business review and concluded we needed a system that:

  • helped us manage the predicted increase in activity
  • offered a service to those that don’t speak English
  • helped us to identify the clinical risk easily
  • was more robust than what we had now
  • didn’t cost us more and ideally saved us money. Our intended cost savings come from flattening activity peaks and thus reducing the need for locums on peak days
  • we wanted to ‘treat’ simple cases rather than double-handling everyone into an appointment.

Once we knew this, we were able to start the process of designing our triage and treat team.

Know your data

We then started analysing our data, looking at call volumes, and patterns of activity. We could see for example we have very traditional activity patterns with most patient contact in the first few hours of the day and spikes at the beginning and end of the week. We tended to react by managing access on the day and therefore feeling nervous of any absence and stretching the on-call GP. We created an excel document to help us think through our activity and calculate how many staff we needed in our triage team. We’ve attached this to help anyone who feels it may be useful. We will set up dates to hold events to talk people through our thinking and learning in January.

Before you start completing the attached excel, you need to consider your model. For example:

  • What will come through online tool? We are currently including general requests like test results and comments but not for requesting repeat meds.
  • Will you let patients send through requests online, that a receptionist will answer on the phone if they call without using the triage tool? For example our patients can ask about general issues, but if they call the receptionist will deal with them over the phone without completing a triage form.
  • Who will be triaging? We have clinicians working on clinical requests but admin answering general queries where they can i.e can you re-arrange my appointment etc.. Will it be GPs, ANPs, ACPs?
  • How long will they take to triage? Our triage to appointments takes under a minute, and care navigation takes slightly longer, but we also encourage our triage clinicians to complete cases that take under 3 minutes. This is helping us to keep our appointments free for those that need them and is adding value, rather than ‘double-doing’ every patient contact.
  • If you have branch sites what will the activity split be?

If there was one piece of advice we could give, it would be the more time and effort you put into planning, the easier the actual go-live.

Our experiences

We don’t want to go into too much detail but for anyone that is wavering or on the fence, we wanted to offer some of the outcomes we’ve seen.

So far we have gone live with our most complex practice in Darnall. We have a high proportion of Non-English speakers and high levels of deprivation.

After the first week we have found:

  • Our calls have reduced by a third. The call length is longer though so we aren’t seeing any improvements in call wait times on the phones yet, in fact they rose on the first few days, but we expected this.
  • Between 50-60% of requests are being submitted online by patients. The rest are still coming through the phone but being added online by reception.
  • We have had a few grumbles, but the overall patient satisfaction rating is hovering above 90%
  • Receptionist who hated the idea pre-go live, are starting to like it, as they don’t have to make decisions about who gets an appointment, with whom and when.
  • The clinicians in the triage team are finding it a change and we’ve scrapped on-call which most found stressful and moved to supervisor roles.
  • We have same day but non-urgent appointments well into the afternoon which was unheard of. The main reason is we are flattening the peaks of activity and GPs are navigating lots of patients away with self-care advice, which receptionists struggled to convince patients of before.

We have no doubt there are more challenges to come, and this won’t solve access in totality, but so far so good…

The next edition will cover things to consider when setting a timeline, for go live