We recently visited St Andrews Health Centre in east London to catch up with GP partner and Accurx user Dr Selvaseelan Selvarajah. We asked Selva how practices can move to a total triage model in line with NHS guidance, all while meeting the needs of patients and staff.
Thanks for speaking with us Selva. To kick us off, could you give us a brief introduction to yourself and your role?
Of course. I’m Dr Selvaseelan Selvarajah, one of the GP partners at St Andrews Health Centre in Bromley-by-Bow. As well as being a practising clinician, I train other doctors who want to be GPs, pharmacists and nurse practitioners. I’m a Programme Director for international medical graduate GP trainees, am on the BMA council, and am the Clinical Lead for an out-of-hour service.
Great, and having been a GP for several years, what do you think the main challenge facing general practice is right now?
One of the main challenges is that there aren’t enough GPs. We’re 2,000 GPs down compared to 2015, and are dealing with 1.3 million consultations a day across the country. That's 20% more than in 2019. General practice receives less than 10% of the NHS budget to do 1.3 million consultations a day and we're the only part of the NHS that's shown a 20% increase in patient contacts since the pandemic.
Those figures certainly say a lot about both the pressures and care delivery in general practice today. Now, I understand that St Andrews moved to a system of total triage in recent years – can you tell me how this came about?
Absolutely. Before the pandemic, we used to have a hundred-yard queue outside the surgery at eight o'clock. It was like Glastonbury tickets, all appointments were gone within an hour. The appointments are gone regardless of whether the patient needed the appointment that day or the following day. It was the classic 8:00 AM scramble.
So we looked at all this and asked ourselves “what's a better way of actually responding to patients’ needs?”. This is when we decided to move to total triage, which meant all patient queries – whether they're from walk-ins, telephone or they're sending it through our website – they all come through one portal. We use Accurx. There's myself, another GP and two admin teams who look at the queries that come through and then signpost patients to the right service. Everything comes into what's called the assigned inbox.
And what happens when a query comes through to the inbox?
First, one of our receptionists will look at it and move it to the right team inbox. If it's a routine query, they'll just send a patient a Self-Book link via Accurx and the patient will be able to book an appointment at their convenience.
It's a much smoother communication between teams. We can get through about 200 to 300 patient queries in a day. Previously, we would’ve probably told half the patients requesting appointments to call back the next day. We have someone pretty much glued to the patient requests and look at them within an hour. And a clinician checks all the actions too so there's that safety net. This system is working really well for us. It's enabling us to manage the demand and map out how many appointments we need to offer.
Do you have any advice for practices needing to manage the change to total triage?
Training, training, training. You need to map out your pathway with your team and train the admin team, the reception teams and make it clear to patients how they're going to use the system. Then you need to work with your clinicians to work out how they're going to triage.
You can’t do it overnight. You need to be looking at how many doctors you’ll need. For our list size – 16,000 patients – we decided we needed four people, two clinicians and two receptionists to deal with total triage. What you can't do is just have one person on triage because they'll quickly be overwhelmed. So the staffing levels, the training and the pathways all need to be mapped out.
Dr Selvarajah training local practice staff at St Andrews Health Centre
What are some of the key benefits you’ve seen from the new triage system?
Well, it’s always disappointing for patients to hear that there’s no appointment available. But we’re not saying this any more. What we’re telling them is that they need to send a Patient Triage request (or we’ll do it for them) and somebody will get back to them the same day. That's really reduced the complaints we get from patients. It’s also helped our reception team who are often at the brunt of patient disappointments. So that's improved morale.
The system has also helped the reception team to upskill themselves. Our receptionists now know who they need to send to the community pharmacy, who they need to send to the social prescribers, who they need to send to the mental health practitioner, the physio and so on. Of course, there’s two of us clinicians supporting them at all times. If they're not sure they can ask, but they've upskilled themselves.
As you’ve said, you use Accurx to run the triage system – so why choose Accurx over other software providers?
The first thing about Accurx is the integration with EMIS. It's very seamless. The other thing is product development. With Accurx, it's a very responsive company. When people [at Accurx] come up with a solution to a problem, you come up with the solution very fast.
A lot of people have said to me that tech can be a barrier between patients and healthcare professionals. But in my opinion, it's actually increased the chance of us being able to book the patient with the right clinician that they want. Consultation takes different forms – face-to-face, telephone, text and occasionally video. We need to focus on triaging patient queries and channelling them to the right clinician and the right service in the NHS. That's the way we need to frame it.