On 6th January 2023, Meadowgreen Health Centre moved to a total triage system with Accurx. Six months on, staff and patients are happier, DNAs are down and Meadowgreen are receiving glowing reviews from public bodies. We caught up with Practice Manager Joanne Johnson to get the full story.
How did you find out about moving to total triage with Accurx?
I went to the Best Practice Show in Birmingham last October and was looking for some ideas and inspiration around how we can be more innovative at Meadowgreen.
While I was there, I learned about a method of running GP practices called ‘total triage.’ From talking with people at other practices and some employees at Accurx, I started to think about how this could help Meadowgreen tackle the challenges we were facing at the time. So I brought back what I’d learned to the GP Partners at my practice and the group made a decision. Starting this year, we officially became a total triage practice, with Accurx at the core of our model.
Can you tell us why you needed to do this in the first place?
The reason we've switched system is because triage was becoming unmanageable. We were getting complaints from receptionists all the time saying: ‘we feel like we're in a call centre. You put the phone down to pick it up, put it down, pick it up’. There was no job satisfaction. It wasn't a nice environment. It was just sad here.
Patients couldn’t get through on the phone. They were often bad-tempered and staff were often left feeling demoralised and unvalued. We'd reached that point where we didn't really think we'd got anything else in our lockers to try. So we thought: ‘let's, let's just do it’. As long as you talk to staff and along the way, you can take them with you.
What were your aims for the new system?
One thing we were very clear about was that it couldn't just be something that ran alongside what we were already doing. That would make it too onerous. We were very aware that you can only have your work coming in through one work stream, otherwise it becomes unmanageable. We didn't want to make any major errors or miss something. I think that's always a risk if you're trying to run two systems. So we just decided ‘in for a penny, in for a pound. We’ll give it six months’. But we're now six months down and it’s clearly working. So it’s definitely staying.
How did you go about getting staff on board and launching the new system?
We did a massive training day for two hours and spoke to all the staff. Then we individually went round each team. We also introduced a duty nurse in the morning. The main thing on that first morning was having a lot of support from people like myself and Elaine, the other Practice Manager and one of the partners.
There were quite a few of us walking the floor, helping staff out, giving them a script of what to say if a patient said: ‘I'm not doing that. Oh that’s a load of rubbish’ or whatever. And just saying ‘no, you'll actually find that you won't have to wait 20 minutes on the phone to get through. You can fill it out later on the sofa with a cup of tea’. And it made a massive difference. It brought patients around.’
We also asked patients to bear with us before we went live. Then about a few weeks afterwards we put a message on Facebook thanking everyone for their patience. We got a lot of likes and nice comments. That meant a lot. It was all a much more pleasurable experience for everybody concerned.
What are the benefits you’ve seen?
For one, staff now know that they're not going to get work dumped on them at four, five, six o'clock. They know they can work through it and actually finish at half past six and that's their day complete.
Psychologically, though the mornings are still pressurised, there’s now an endpoint because we stop accepting medical requests at midday. This means reception staff can stop and take a breath. So it works really well. We have an older member of our reception team who works full-time for us. She was really nervous because obviously it was a change. And at the end of that first morning using Patient Triage she looked at me and she said: ‘I love that’.
Patients love it. Now we have Self-Book, they can now choose when they want to come in rather than reception saying ‘you can come on such a date at such a time’. Before this, they would often DNA and say ‘I'll check my diary when I get home’ then never cancel.
What would you say to a practice who was nervous about changing to a total triage system?
Firstly, I’d say to go to practices where total triage is working and watch it in action – you can learn so much.
I’d also say that if you're not happy with or you can't manage what you've got, you've got to be open to trying something different. It doesn't have to be forever. Just because you’ve had the same process for years, doesn’t mean you can’t change it. You can.
Yes, you might annoy your patients and confuse your staff at first but it can be tweaked. Treat it as a work in progress. You can even do it slowly if it helps. You could introduce Patient Triage for just two hours in a morning to start with and run two systems. That's not how we did it at Meadowgreen. But that's not to say that's not possible.
Any other tips you’d give?
You need to get your staff on board. You need to get them so they’re willing to give it a go. We were honest with our staff and we said ‘we'll try it for six months and if we find it's not working or it's making things worse or we're getting complaints, then we will of course re-look at it’.
Even on the days we had our doubts, it was really important that any nervousness was never conveyed to the staff – that it was always done very positively. The partner that managed the change with us was very enthusiastic. We just had to guide staff along and were confident that once we did, they’d feel like we did about the change. But it's just pushing through those doubts and supporting staff along the way.