Clinical Triage Update

Friday, 20 October 2023

Dear Patients,

As we approach the 6-month mark with the new clinical triage system we wanted to write to outline a little of what we have noted with the approach.

We understand whenever there are big changes it can take time to make sure we do a good job at ensuring everyone understands the change and its benefits. We wanted to write today to update our patients on the impact clinical triage is having.

The previous experience of having to hold on the phone at 8am or having to ring the next day when there is no capacity is no longer a challenge. Patients have found it useful to use the online form to submit a clinical issue at any time the practice is open without a phone wait to struggle with. For those that would like to use our phones, the waiting times have improved as a result. Although not perfect every time, the improvement is helpful for those patients not so familiar with the online route. Where people struggled to overcome the barriers to letting us know what’s wrong, those patients can now take more time to consider and contact us without that stress. We are reaching those patients who found it hard to reach us.

So how about from a medical perspective, the clinical triage model helps us review medical need and spot serious conditions much more effectively. The clinical team can and have been triaging 75 to 125 clinical requests per day. This means all presenting complaints are reviewed by senior clinicians and managed in the safest and most appropriate clinical way. This can include urgent review at the surgery, review at our NHS partners, the urgent care centre or for those patients very unwell the emergency department. All our requests receive a senior clinician triage within 48 hours, something never previously achieved.

When our clinical triage team review requests some minor ailments that would be best supported by self-care may not get prioritised for the same day, but the clinical team can spot those patients with serious cancer symptoms, stroke or heart symptoms or unwell children that need rapid assessment and then ensure there is capacity to call those patients in face to face with no barriers.

Examples in the past six months include patients with cancer symptoms requiring 2 weeks wait cancer referrals reviewed within 48 hours and referred, investigated by hospital, and receiving their treatment in record time. Some of these cases have been treated with a view to curing the cancer which with more time may have spread. Other examples have been identifying patients with heart symptoms to prioritise those to same day. Without clinical triage these cases may have waited the standard GP waiting time our patients experienced before triage at 3-4 weeks.

The benefits on access are also substantial. If at triage, the clinical team would recommend a face-to-face review this can now be actioned and booked much earlier than ever before. When patients are identified as needing a face-to-face appointment this can now be booked at 7 days for GPs, telephone appointments for GPs within 13 days, Advanced Clinical Practitioner appointments bookable within 12 days and Advanced Clinical Practitioner telephone appointments bookable in 11 days.

Where the national average wait for these routine appointments is now pushing past 4 weeks, we are aiming to maintain our waits to 14 days or less. We are aware that this won’t always be possible and sometimes patients do wait longer, the difference however to the national picture is stark. We have also had the opportunity to work closely with Girish in Lowdham Pharmacy for minor ailments improving access for patients that are better supported by pharmacy colleagues and providing better access for our Lowdham patients presenting with these conditions.

Our clinical triage has also been noted throughout the Nottingham area and there is significant interest in learning more about it so that some of these concepts could help other practices struggling to make sure they can meet patient need.

Although delivering this volume of daily triage reviews has been a significant challenge for our teams, the clinical benefit for patient health has been significant and we hope to continue to improve patient experience as we go forward. The alternative of going back to patients struggling to get through to let us know what’s wrong, longer waits with averages in the UK being 3-4 weeks and seeing serious conditions diagnosed later means we are passionate about delivering the benefits of clinical triage for our patients.

Thank you for your support.

Your Practice team, Ivy Medical Group.