GP triage is a telephone-based service that increases capacity for practices and convenience for patients by triaging those patients requesting a same-day appointment.
Why should we implement GP triage?
It allows a practice to identify why a patient wants to be seen and then decide the most appropriate outcome for that patient. It ensures same-day appointment slots are reserved for those with a true same-day need.
Evidence from practices undertaking GP triage suggest that approximately 50–60% of patients requesting same-day appointments can be managed without needing to come into the practice. These requests are also resolved faster than the standard 15-minute consult.
What are the benefits?
Increased capacity to see patients.
Reserves on the day appointments for those who actually require them.
Improved access to doctors: patients have access to doctors when they need it, within 10 minutes from calling the practice.
Avoids unnecessary visits to the practice.
Increased patient satisfaction.
Who does what?
Answer calls according to triage script and enter patients into doctor triage template as appropriate
Process paperwork associated with costs
Book same-day appointments as appropriate
Generate paperwork associated with costs
Data collection (triage codes)
Allocate physical space for GP triage room
Adjust GP hours to cover peak morning period (8–9am)
Arrange increased telephone system capacity
Organise training in booking appointments for GPs
Follow up any patients the GP is unable to contact
When should we use it?
Use GP triage during peak call periods – for many practices this is between 8am to 9am. You can use GP triage every day your practice is open. However, Mondays and Fridays are the busiest days for many practices, so you may need to allocate more GPs to do triage on these days.
How will it affect staffing?
If your GPs currently start consulting at 8:30 or 9am, you may need to adjust their hours to cover the peak morning call period. Because GP triage is quicker and more efficient than face-to-face appointments and frees up appointment time for patients who need it, you may find that your practice can see the same number of patients with reduced FTE (full-time equivalent) GPs.
Will we need additional resources?
Yes. You will need:
a room for GPs to do triage
a call monitoring telephony report
additional telephone capacity as you may need to consider increasing the number of incoming lines during peak call periods. Tracking your dropped call rate and complaints from people unable to get through will help you refine this for your own practice.
You may also need an additional separate outgoing line so that doctors doing triage can reach patients quickly and easily.
Pukekohe Family Health Care (PFHC) has increased patient access by a third with an innovative GP triage model.
The practice needed a solution to cope with the busy winter period. They had lost 1.6 FTE GPs, and receptionists were overwhelmed with the number of people ringing in asking for same-day appointments.
In addition, patients needed improved access that would better meet their needs.
“The traditional 8am–5pm appointment system wasn’t always cutting it for our patients. They needed access that fitted in with work and didn’t necessarily involve them having to come in and be seen by a GP,” says Dr Selena Green, medical director.
Pukekohe Family Health Care used improvement methodology to create a telephone-based GP triage system. Their aim was to see the same number of people as in the previous winter, despite the reduced FTE.
In the GP triage system, receptionists advise patients who request a same-day appointment because they feel unwell that a doctor will ring them back within 10 minutes. A GP then contacts the patient to determine how their needs can be met most appropriately.
The practice started small, with Dr Green testing the system for one day each week, and then expanded over a 3-month trial period by including willing GPs. The system now operates from 8am–9am, Monday to Saturday. Three doctors do triage on the busiest days, Monday and Friday, and two on other days. All but one of PFHC’s doctors take part.
GP triage has now been operating for 18 months, and is consistently saving time and money for the practice.
“We’ve gone down from about 10 FTE GPs to about eight, but we’ve increased our capacity by a third, which means we’re seeing a third more patients on a daily basis with fewer GPs,” says Ms Tryon.
In addition, the system has improved access for patients by freeing up face-to-face appointments for those who need them and offering a more efficient way to meet the needs of those who don’t.
“It saves patients time off work, petrol money, those sorts of things. People who just need a prescription or an off-work certificate can collect them from reception within minutes,” says Ms Tryon. “We stopped measuring patient satisfaction every day because we were getting positive responses all the time.”
Patient safety has been a priority throughout the project. GPs have access to patient notes and often triage their own patients. They also make it clear to patients and GPs alike that GP triage is not about trying to stop people coming in and being seen.
“If a patient says they just want to be seen, or a GP has any concerns about dealing with a person over the phone, we will see them. And we make it clear to people that they can contact us again for a face-to-face appointment if they continue to feel unwell. We’ve had no issues at all,” says Dr Green.
“In fact, the increased capacity improves patient safety because GPs have more time available for appointments to see priority patients quickly, and a GP is better able to make the call about who needs to be seen than a receptionist or a nurse.”
Going forward, the practice aims to move towards GPs triaging their own patients and, eventually, to offer phone consults. They are also keen to share their success story to help other practices implement their own GP triage systems.
Download case study (pdf) from Counties Manukau Health here.