Insights, news and views from the team.
November 15, 2023

Total triage: 10 tips to beat the 8am rush

A few weeks ago, I had the pleasure of speaking at The Best Practice Show – an event where 4,000 professionals gather to debate and discuss the challenges facing primary care today.

I shared 10 tips that we’ve learnt from practices who have adopted a total triage model and tackled the 8am rush. The highlight for me was our on-stage discussion with Dr Johan Byran, a GP Partner at The Crouch Hall Road Surgery, whose practice has radically improved patient access and staff morale since implementing total triage.

In case you missed it (sorry if you were one of the people turned away!), here are the key learnings we spoke about.

#1 Make it as easy as possible for patients to submit a request

This feels counterintuitive. But we've found that, if patients struggle to submit an online consultation form, they often end up calling the practice or turning up at the practice reception. Practice websites are the best place to do this - here’s a great example. It should almost be uncomfortable how easy it is for patients to get in touch.

#2 Triage all inbound in the same way 

Whether from the practice website, phone, NHS App or walk in, triage all inbound in the same way. If patients present in-person or phone, make use of our feature Reception Flow, which lets practice staff submit a streamlined version of the online consultation form on a patient’s behalf and supports digital inclusion. When everyone is asked the same questions, you can triage and action all inbound in the same way, from a single list. If you only triage online requests, patients who go online are competing for capacity with patients who call up at 8am and aren’t triaged - a guaranteed recipe for overwhelm.

“If you ask any of the reception staff, they will straight away tell you that the phone calls have fallen off considerably. They can actually spend more time on the phone for those people who genuinely can’t use the internet to use the online forms and help those people.”  Practice Manager feedback from Accurx annual user survey

#3 Have an experienced GP triage, and pair them with an admin or trainee

As triage is a ‘new’ activity, many practices try and protect their clinical capacity by putting junior or non-medical staff on triage. But administrators or trainees have an understandably low threshold to booking patients directly into appointments. Triage isn’t part of medical training (yet) but is an acquired skill over years of experience, so you need your experience GPs doing it.

The practices who take this to the next level pair their triage GP with other team members. Either an administrator who can action the GPs decisions (e.g. ordering an X-ray), and/or a GP trainee, who can learn how to triage effectively.

By having an experienced GP triage, the average request is marked ‘Done’ 38 minutes after being first opened.

#4 Assign requests based on continuity of care and the skills of staff

There’s been a huge push on additional roles (even long before ARRS), but it only works if you’re assigning requests to the right people. Otherwise the AHPs get busy, but don’t shift any work from GPs. Triage lets you do this.

Triage lets you also assign for continuity, but only where continuity matters. 

The Accurx inbox allows you to assign requests to admin or medical teams, and you can see who in the practice is working on the request. 

“It helps us to know when someone else is actioning a triage request so we can move on to another and saves double handling, hence reducing time to action requests." Feedback from Accurx annual user survey

#5 Collect structured data with a Florey, when more information is needed

Sending a patient a questionnaire saves valuable time, since patients can answer standard questions about their condition in their own time, whether they’re presenting with a UTI, sore throat, or lower back pain. Once you get the information back, you can then make a more informed decision about what to do with their request. Over 10,000 Custom Floreys, have now been created by our users. 

One benefit we didn’t expect but have heard from practices, is that Floreys are picking up rare but serious complications (e.g. cauda equina from a lower back pain presentation, pelvic inflammatory disease from a query UTI presentation) that wouldn’t have been picked up in a quick phonecall, because patients can take more time to answer more questions.

#6 Make it easy for patients to reply, so they don’t have to start over again 

This again sounds counterintuitive. But if patients can’t reply, they have to go back through the triage process, which is inefficient for everyone. Giving patients the ability to reply makes them much more comfortable being told to see how symptoms progress over time, because they know there’s a route to get back in touch. You’ll also be surprised at how many messages simply saying ‘thank you, I’m feeling better now’ come back

#7  Work from the inbox, not the appointment book

If you work from the appointment book, it’s as efficient as putting every email you get into your calendar, for five minutes regardless of the effort involved, and then going back and forth between your calendar and email to get through work. It’s inefficient and there is no ability to collaborate. Accurx’s inbox was built for collaboration. 

#8 Resolve as much as possible with messaging 

If you only take away one learning, it’s this. The most advanced practices are resolving 25-50% of what would have been an appointment before COVID, through messaging. Appointments have gone from being ‘first line’ management, to ‘second line’. This is the only way we know of that practices can truly increase productivity, because each request can be dealt with using less clinician time. Practices are also seeing that in many cases patients prefer this, rather than having to come in or wait around for a phone call.

#9 Inform patients how the system works at every touch point 

Moving to a total triage model takes a big behaviour shift from patients, and this takes time and effort. Total triage practices use every touch point to educate their patients in the benefits of the new system, whether it’s on their website, or taking 30 seconds at the end of the appointment a patient insisted on to explain ‘next time we can help you a lot sooner if you answer a few simple questions first’.

#10 Never stop iterating

Every practice that has implemented total triage has found the first 4-6 weeks really tough, and every practice has had an ongoing list of improvements they’ve had to make. This ranges from sending nursing staff for additional training and tweaking the messages reception give patients, to building dedicated rooms for triage and changing GP session times.

Practices use historic demand data to plan and tweak their capacity, for example planning routine capacity around capacity for triage.

Sharing our learnings, and listening to those of others

A student District Nurse from Birmingham, a GP Partner from Nottingham, a Clinical Lead from Manchester – there's always such a variety of attendees at The Best Practice Show, each contributing their own insights and learnings to the primary care community.

A big thank you to everyone who came along and spoke with myself and other members of the Accurx team. We always look forward to this date in the diary and love having the opportunity to speak with the people who use our software, listening to their experiences and learnings so we can keep improving Accurx for them.

The best feeling for us is learning how NHS staff are taking our simple tech and innovating upon it, inventing new solutions and ways of working that we could never have imagined.

Need support moving to total triage? Download our report today to learn more or contact to see how Accurx can help your GP practice, ICB or PCN take control of patient demand.