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 firstname.lastname@example.org.
Choosing an online system
The ICB are currently funding AccRX. This system is being used by several large practices in Sheffield as a triage tool and it is working well for them. We didn’t choose AccRX because it wasn’t right for us, but we do believe it could be right for many. We’ve been asked why we made our decision and paid for the system; the main reasons are below:
- AccRx cannot handle more than 1 GP system at once- we cannot see why this would be an issue for anyone in Sheffield but us, unless if you have plans to deliver services in partnership or as a PCN for example.
- It did not offer translation of the online questions/responses. This was a critical for us given our high non-English speaking population.
- It doesn’t use the patients answers to RAG rate which is the most urgent request to look at. This was an issue for us due to the volume of requests in our triage hub (from 45,000 list size), it probably won’t be as critical for others.
Setting your timeline/project planning
Once you have your plans in draft, we recommend setting a timeline for go live with plenty of time to work through the actions you need to undertake. Once you have a timeline you can start warming everyone up.
Things you may want to consider as part of your timeline and associated project planning include:
- Create a project plan so you don’t forget things along the way.
- IG governance, Data protection impact assessment and clinical safety sign off processes take time and need factoring in.
- Thinking about the positives you want to sell, but being realistic about the challenges, such as potentially longer call waits especially when the system goes live.
- Communicating with your PPG and gaining their buy in.
- Wider communication with your patients, including what it means for those that cannot go online.
- Looking a standard operating procedure. Will you have any rules about how you manage the patients? We created a document with screen images of click here to do Y, and there to do X. It took a bit of time upfront but reduced the amount of effort with training and go live, as staff had a reference document to look at.
- Deciding your triage team minimum staffing but also reviewing your onsite team. Presumably it will be a re-allocation of staffing rather than additional staffing.
- If you are using salaried GPs, do you have a job plan to explain what these sessions will look like? Ours was an addendum as staff were changing from ‘normal sessions’ to ‘triage session’ so it was an add on to people’s job plans, not an overwrite. Attachment included if useful.
- Who will be best placed in the triage team? We met a team from Doncaster who only use partners to triage. Our learning is confidence to make decisions and IT skills are a must, but actually some of our newly qualified GPs and ANPs are doing amazingly well.
- Training for clinicians and reception staff, how, when by whom? When considering your training the IT supplier will often deliver training on the system. Will this be enough for you staff to know your model? When we talked to others that had gone live, they advised us the IT systems provider training was not enough for teams to understand the practice plans. We therefore ran a day of 1-hour sessions where we not only re-ran through the ‘w’ on a demo system that buttons to press but also fed in what we wanted and of the team and our processes.
- How will reception ensure requests they feel are urgent are flagged to the triage team? In our system you can click a button as part of the triage which makes the request stand out.
- What is the unique functionality of the system you have chosen; how do you make best use of it?
- If you are recruiting is this a tool? We found lots of applicants were really interested in learning about our plans.
Most recent update of how we are going
- Patients choosing to make requests online has peaked at around 58% a day (bear in mind this is in a deprived mainly non-English speaking population)
- The call reduction has also plateaued at 1/3rd reduction in call volume per day.
- Call lengths are still about double what they were before implementation. This is meaning call waits are longer than they were pre go-live.
- We are seeing increases in activity. It’s hard to know if that is season or total triage related. However anecdotally we are seeing more general ‘I’ve had spotty skin for 3 years’ type queries.
- We are still keeping appointments available later into the day.
- We have seen patients trying to circumnavigate with answers like private, but we are remaining firm on needing responses between them and the clinician to decide on the next course of action.
- We believe we are diverting more patients to self-care etc.. than ever before, and our use of EA and other appointments has decreased.
- It is very clear patient expectation and reality are mismatched, and the triage tool has perhaps increased expectation. If we were re-starting we’d put more emphasis on defining what patients can expect.