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NHS Abandons "Total Triage"

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duncanp

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Some good news, it seems, as the NHS (in England at least) is going to abandon attempts to force people to speak to a GP over the phone before getting a face to face appointment.

I wonder how easy it will be in practice to speak to a GP though.


Every patient to have right to see a GP as NHS abandons ‘total triage’

Climbdown comes after The Telegraph revealed patients were being discouraged from visits and told to have online or phone discussion first

The NHS on Thursday night performed a climbdown over plans to use online and telephone "screening" for GP appointments and announced that every patient would now have the right to see their doctor face-to-face.

The Telegraph revealed on Wednesday that family doctors had been told to introduce a system of "total triage", meaning those seeking to see their GP were being discouraged and told to have an online or phone discussion first.

But NHS England has now ordered that the system be abolished amid a mounting backlash from patients' groups and doctors. New guidance to all GPs will instead say that every practice in England must make "a clear offer of appointments in person" and respect the preferences of patients.

Dr Nikki Kanani, the NHS medical director for primary care, and Ed Waller, the director of primary care, wrote to all GPs on Thursday night to inform them that the new operating procedures supersede all previous guidance.

GP practices must all ensure they are offering face-to-face appointments," the letter says. "While the expanded use of video, online and telephone consultations can be maintained where patients find benefit from them, this should be done alongside a clear offer of appointments in person.

"Practices should respect preferences for face-to-face care unless there are good clinical reasons to the contrary, for example the presence of Covid symptoms."

It came after the Patients' Association, the Royal College of GPs, the British Medical Association and Jacob Rees-Mogg , the Commons leader, all raised concerns about the NHS proposal for "total triage".

Ohe Telegraph has been inundated with letters from readers describing problems accessing GP care – with one likening their local surgery to Fort Knox – after it highlighted the problems.

On Thursday night, Prof Martin Marshall, the chairman of the Royal College of GPs, said: "This is good news and is what patients and GPs want to see.

"It removes all ambiguity, and we're particularly pleased that our calls for shared decision-making between GP and patient on the most appropriate method of consultation have been heard. We now have a flexible approach decided upon by clinicians and their patients."

The system of "total triage" was first introduced at the start of the pandemic in an attempt to keep patients away from GP surgeries and reduce the spread of infection. The advice became formalised in annual NHS planning guidance which came into force last month.

NHS England had always said anyone deemed by a doctor to require a face-to-face consultation should still be able to get one after undergoing remote assessment. But the national system has now been scrapped amid increasing concern that patients were being denied care they needed.

Oe pensioner told how she had made more than 100 calls a day to her local surgery in Kent on behalf of a neighbour in her 90s in an attempt to get an appointment. When she finally got through, she was told the only way to be assessed was via an online consultation.

Hundreds of readers highlighted their struggles to access care after The Telegraph reported the case of Joy Stokes, 69, who died from cancer after months of being refused an appointment.
 
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duncanp

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Indeed, especially as this was an issue with a lot of GPs before COVID anyway.

Yes.

People struggling to get an appointment with their GP.

Receptionists treating patients like something the cat has just dragged in.

It's nice to see some parts of the NHS are getting back to normal.
 

IanXC

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Well in my experience this is very much a backward step. My GP was always a total bun fight every morning if you wanted to *attempt* to get an appointment.

Prior triage, and the GP phone back list, means I can call in and expect a call back that day, prescription or sick note issued and posted first class, or a face to face appointment the following day.

Much preferable to the bun fight... Ah well it was good while it lasted.
 

ainsworth74

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Well in my experience this is very much a backward step. My GP was always a total bun fight every morning if you wanted to *attempt* to get an appointment.

It's always interested me how different each GP surgery is from the other in how they handle things. Pre-pandemic my GP surgery was a bunfight if you wanted a same day appointment but if you didn't want to get involved in that scrum or if by the time you got through on the day appointments had gone they'd be happy to arrange you an appointment (face to face) for the following day or at some point in the next couple of days. I seem to recall if it was urgent they'd normally arrange a doctor or nurse to call you the same day to triage appropriately. But that as a system worked quite well in my view. You could also make appointments online if you were signed up to do so.

Since the pandemic though it's bunfight only. They only make appointments for the same day and only by telephone so you have to ring at 8am when they open and, of course, because everyone is ringing you can never get through so just have to keep calling and calling and calling until you do get through and hope there's an appointment left. The appointments are all telephone only (face to face is only if decided to be absolutely necessary, but to be fair, they have been available I think throughout). My record was around forty calls before it finally connected and put me into the queue (and to be fair I did still get an appointment but still).

So my hope is that this change might get my surgery to stop their stupid "we only book appointments for today" system and allow you to book appointments properly in advance again.
 

davews

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Bring back the days when they unlock the front gate and you can actually walk in and book an appointment in person, which is how I always used to do it. I see in their latest newsletter that our surgery has just got a new surgery manager, maybe good, maybe not, will wait and see.
 

westv

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I remember in the 70s and early 80s the surgery round the corner from me didn't have an appointment system. You just had to turn up and wait your turn!
There was also only one doctor.
 

bramling

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It's always interested me how different each GP surgery is from the other in how they handle things. Pre-pandemic my GP surgery was a bunfight if you wanted a same day appointment but if you didn't want to get involved in that scrum or if by the time you got through on the day appointments had gone they'd be happy to arrange you an appointment (face to face) for the following day or at some point in the next couple of days. I seem to recall if it was urgent they'd normally arrange a doctor or nurse to call you the same day to triage appropriately. But that as a system worked quite well in my view. You could also make appointments online if you were signed up to do so.

Since the pandemic though it's bunfight only. They only make appointments for the same day and only by telephone so you have to ring at 8am when they open and, of course, because everyone is ringing you can never get through so just have to keep calling and calling and calling until you do get through and hope there's an appointment left. The appointments are all telephone only (face to face is only if decided to be absolutely necessary, but to be fair, they have been available I think throughout). My record was around forty calls before it finally connected and put me into the queue (and to be fair I did still get an appointment but still).

So my hope is that this change might get my surgery to stop their stupid "we only book appointments for today" system and allow you to book appointments properly in advance again.

Bunfight at mine. It's a case of who can get onto the queue quickest enough at 08:30:00 on the dot. A typical experience is on the phone right away, 37th in the queue, on hold for 45 minutes, and when finally do get through get told there's no appointments today, be given the option of speaking to a doctor if it's an "emergency", and then sniped at if the doctor judges it isn't after all urgent.

Thank you NHS, you're so wonderful!
 

Ostrich

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Every surgery is different, and every surgery unfortunately has its own problems.

I started using eConsult (which is the online vehicle for Total Triage) in March 2020 to request repeat prescriptions, using the Administrative option. This was at the surgery's request. From December 2020, however, the system effectively broke down; repeat prescriptions were simply not getting transmitted to the pharmacy - and I know I wasn't the only punter affected. After 4 months of hassle, I have gone back to posting hardcopy requests through their letterbox - so much for modern technology! :smile:

The surgery introduced Total Triage for appointment booking in mid-April. Judging from local social media, the resulting problems have been manifold, even to the extent that the local MP has been involved. I do not think many folk around here will be shedding tears that the roll-out has been scrapped.
 

Trackman

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Well in my experience this is very much a backward step. My GP was always a total bun fight every morning if you wanted to *attempt* to get an appointment.

Prior triage, and the GP phone back list, means I can call in and expect a call back that day, prescription or sick note issued and posted first class, or a face to face appointment the following day.

Much preferable to the bun fight... Ah well it was good while it lasted.
Same here, I used to call for a relative and conference call it so to speak as she didn't know what was going on.
I knew if I rang at 9am, he would call about 11am as they would give me a slot.
Bunfight at mine. It's a case of who can get onto the queue quickest enough at 08:30:00 on the dot. A typical experience is on the phone right away, 37th in the queue, on hold for 45 minutes, and when finally do get through get told there's no appointments today, be given the option of speaking to a doctor if it's an "emergency", and then sniped at if the doctor judges it isn't after all urgent.

Thank you NHS, you're so wonderful!
In the early days of Covid I had this problem with said relative in my above post.
Because it was a priority, they gave me a nondescript email address to use.
There was also a message if it's an 'emergency' to call NHS Direct adr they would decide if you need hospital treatment or whatever.. good luck getting through to them.
 

johnnychips

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Erm...I had a problem ‘down there’ which wasn’t related to sexual activity, but I honestly thought that any problems in that area had to be dealt with by the sex clinic. Anyway, I rang up at 0830, had a chat with a doctor and had an appointment at 1100. Doctor was great, she said she might as well have seen me anyway as they - perhaps understandably - get a lot of no-shows. Pre-Covid they were a walk-in service.
 

island

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I like the idea of having phone appointments/triage available and I don’t really mind that being the “gate” to the system as long as there are actual appointments and not a “first N people to get through at 8am” situation.
 

RuralRambler

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I remember in the 70s and early 80s the surgery round the corner from me didn't have an appointment system. You just had to turn up and wait your turn!
There was also only one doctor.
Mine did that until around 2005! Mornings were turn up and wait. Then there were timed appointments in the afternoons that you could book in advance. It worked well - people who needed "urgent" appointments just turned up. Those with conditions requiring regular follow ups/reviews booked for the afternoons, which were "allowed" several weeks ahead, so you could book a follow up there and then if GP said they wanted to see you again in a month's time. But our GPs also did their own blood tests, if needed, there and then too, rather than referring to to make an appt with a HCA a few days later (took less time to take the blood than it took the gp to write the referral slip!).
 

pdq

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My surgery is brilliant. It has been using an app for bookings for years (in addition, of course, to phone calls). The booking functionality was suspended, though, until recently.
I've just looked, and today is booked (though I'm sure there will be some emergency appointments available), tomorrow has some spaces, and appointments are available to book for the next 6 weeks.
This is so much more efficient for me than phoning up on the morning, especially for routine BP checks etc.
 

peters

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Indeed, especially as this was an issue with a lot of GPs before COVID anyway.

Yes.

People struggling to get an appointment with their GP.

Receptionists treating patients like something the cat has just dragged in.

It's nice to see some parts of the NHS are getting back to normal.

I'm not sure if triage made that worse though. Pre-triage you had to convince the receptionist you needed a more urgent appointment than one next week, which was really a case of how good your negotiation skills are rather than how sick you were. Triage meant you could speak to the doctor the same day even if you couldn't get a proper appointment the same day and the doctor decides the priority not the receptionist. Saying that if the doctors are making more phone calls they won't have as much time for face to face appointments.

If you don't need a physical examination a telephone appointment could be an advantage but I find you often don't get a fixed time for one but a vague 'the doctor will phone you this morning/before the surgery closes' which isn't so good.

This is so much more efficient for me than phoning up on the morning, especially for routine BP checks etc.

That raises an interesting point. A blood pressure reading can be taken by a nurse or a GP, so would it not fall into the category of it's best to book with whoever has availability the week it's needed rather than booking too far in advance?
 

IanXC

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I'm not sure that not getting a fixed time for a call back is that important? Certainly if I was happy with an appointment next week I'd be more than happy with a call back today, or, if I was really unwell, then I'm at home anyway so what difference does the time of the call make?

What has come to mind is a GP surgery I used when I lived elsewhere, where the manoeuvre was to accept an appointment with a Nurse (which were always available, typically within the hour) should your condition need a Doctor they'd reappear with one within a few minutes...
 

peters

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I'm not sure that not getting a fixed time for a call back is that important? Certainly if I was happy with an appointment next week I'd be more than happy with a call back today, or, if I was really unwell, then I'm at home anyway so what difference does the time of the call make?

The way I see it if a phone call can prevent you from having to travel from your workplace to the surgery in another town then it's beneficial. However, if you're in a workplace with a poor mobile signal or you might be in an important meeting for one hour then not having an approx time could mean you miss the call.

I once got a call while walking from my desk to the kitchen, unfortunately that meant my phone was in a blackspot at the precise moment the doctor called. A few seconds later I would have been in the kitchen, where there was a window and a signal.
 

jon0844

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The NHS app would appear to let you book a GP appointment from within the application. I have not tried it to see if it has many ways to hinder the process!

This app will also be the vaccine passport proof at some point I believe.
 

PeterC

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The NHS app would appear to let you book a GP appointment from within the application. I have not tried it to see if it has many ways to hinder the process!

This app will also be the vaccine passport proof at some point I believe.
I downloaded that last week but my email provider thinks the link in the confirmation email is suspect and won't deliver it.
 

westv

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The way I see it if a phone call can prevent you from having to travel from your workplace to the surgery in another town then it's beneficial. However, if you're in a workplace with a poor mobile signal or you might be in an important meeting for one hour then not having an approx time could mean you miss the call.

I once got a call while walking from my desk to the kitchen, unfortunately that meant my phone was in a blackspot at the precise moment the doctor called. A few seconds later I would have been in the kitchen, where there was a window and a signal.
Indeed or you might be driving, on a train and don't want to be overheard, on the loo etc..

I downloaded that last week but my email provider thinks the link in the confirmation email is suspect and won't deliver it.
My email provider has a "spam" folder these things go to.
 

peters

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My email provider has a "spam" folder these things go to.

The likes of Outlook (free) and Yahoo Mail make some spam emails disappear rather than get delivered to your spam box. It's rare that a genuine one ends up not being delivered though, usually the ones you don't get are known phishing scams so you don't realise they haven't been delivered.
 

PeterC

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The likes of Outlook (free) and Yahoo Mail make some spam emails disappear rather than get delivered to your spam box. It's rare that a genuine one ends up not being delivered though, usually the ones you don't get are known phishing scams so you don't realise they haven't been delivered.
Emails containing links to websites are vulnerable to this sort of deletion. In the last few weeks my provider has failed to deliver emails containing confirmation links from three different sources.

Most email providers do some sort of server level blocking although Outlook (formerly Hotmail) and Yahoo had the worst reputations. I know of one company that lost a lot of business because Yahoo blocked a broadcast to customers about changes to terms of service.
 
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Killingworth

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Back in the dim distant past my uncle's father held his surgeries 2 a day Mon, Tues, Thurs and Friday one on Wednesday, Saturday and Sunday, first come first seen, line up on the bench and queue outside if busy. Morning and afternoon rounds of home visits. On call every night

Sole practice in the country, when my uncle took over in 1947 he axed Sunday surgery. Otherwise nothing changed much by the time he retired in 1971 - at which point the practice was closed down.

When I return to that village people still remember old Dr C and young Dr Pat with affection. Their bedside manner 'cured' many a complaint. A box of chalk pills, a bottle of sugary medicine could do wonders!

Impossible to do today. Thanks to mobile phones and electronic communications patients now know more than the doctor, or think they do! So many more ailments to be aware of, treatments to consider, plus data protection and all the rest. Even in 1971 my uncle was glad to get out.
 
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