‘Remote by Default’: Exploring the use and experience of total triage and remote consultations

Background

Before COVID-19 we might have been offered a telephone appointment some of the time, but most of the time, people were offered, and wanted, a face-to-face appointment. Since COVID-19, most people’s appointments have been over the telephone, with only a small number of people seeing their General Practitioners (GPs) face-to-face in the General Practice surgery or via a video-call. This was to ensure patient and General Practice staff safety. During COVID-19, when we have tried to book a GP appointment, we have all had to go through a system, called a ‘triage’ system, that decides how we are seen and who we are seen by. Decisions as to who got an appointment, when and what type of appointment (face-to-face, telephone or video-call) were made either by receptionists, Nurse Practitioners and/or GPs over the phone or alternatively by patients, or their carers, filling in a form online which a member of GP staff would then use to decide the need for and type of appointment that patient would get. This system essentially removed patient choice for appointment type which is why it is called ‘total’ triage. The government recently (13th of May 2021) announced a change to allow patients a choice again of what type of consultation they feel they need, including face-to-face. How patients and GP practices respond to this new announcement is a question we will explore as part of this research.

There has been little research into patients’ experiences of total triage being not only rapidly introduced but used routinely across all practices for all patients. In particular, we would like to know if any groups of people have found it more difficult than others, and why. For example, people who have hearing, visual or other impairments, might have struggled if their GP service is using one system vs another. We also want to know how patients with complex medical needs and those from vulnerable groups or disadvantaged backgrounds have found the total triage system. General Practice staff have also had to get used to these new ways of working and there is little understanding of how GP staff are making triage decisions under total triage, or how doing most of your work by telephone for example, might affect their feelings towards their work, how they are working with the potential for impact(s) on patient safety of particular concern.

Aims

This study aims to find about patient and General Practice staff routine use of total triage systems. In particular:

How GP staff have implemented total triage

How patients are being triaged under total triage and why,

What the advantages and disadvantages of using total triage are for patients and General Practice staff with including any perceived impact on patient safety.

Methods

We will interview patients and GP staff (receptionists, Nurse Practitioners and GPs) to find out more about what people think about total triage systems, how they were introduced, how GP staff and patients have responded to these changes and what the impact on patient safety might be. We will interview a variety of patients and include people who might have particular issues in using these new systems. We will involve patients and the public at all stages of the research.

Expected outcomes

Our findings will help us design a larger set of studies and produce information to help highlight any particular issues that needs attention, resulting in changes so that patients and General Practice staff can use total triage systems in the best and safest way possible.

Amount awarded: £48,034