The COVID-19 pandemic saw unprecedented challenges for primary care teams up and down the country. One particular wholesale change for many practices was the introduction of total triage: meaning GP practices have to provide patients with access to online consultations, online personal detail updates and electronic communications.
Though an effect of the pandemic, the total triage model has proved its staying power with plenty of practices, who have found it an improved model of access to the practice for their patients. We sat down with Dr. Toby Wallis, Dr. Joanna Dingley and Dr. Charlotte Hillsley from Fordingbridge Surgery in Hampshire to find out more about their journey with total triage, how Anima’s care enablement platform has helped them to implement the model, and their top tips for any other practices looking to successfully get started with total triage.
What is total triage?
Image credit: NHS England (https://www.england.nhs.uk/coronavirus/documents/advice-on-how-to-establish-a-remote-total-triage-model-in-general-practice-using-online-consultations/)
Total triage means that every patient contacting their GP practice first provides some information on the reasons for contact, and is triaged before making an appointment. NHS guidance suggests that using an online consultation system is likely to provide more benefit than doing this entirely over the phone - something that the Fordingbridge team definitely found to have been the case. Dr. Wallis remembers that “when total triage models had failed in the past, it was all-phone based… they didn’t have half as many tools as we have now available to us. We’ve got a lot more to play with than we had before”.
During the pandemic, total triage was important to reduce avoidable footfall in GP practices to protect patients and staff from infections, but even post-pandemic the model of access is still popular and the Fordingbridge team have found it remains the best model for them:
Although it started as a sort of crisis measure, it's become something that we think is actually better for the patient.
They’re not alone; some call total triage “the future for general practice” - a tool that can help practices manage their workload, make best use of multidisciplinary teams, maximise efficiency, and improve patient care.
When did you start using total triage? Why have you kept it following the pandemic?
Fordingbridge introduced total triage in December of 2021, initially to help manage workload in the run-up to the Christmas period, and having “been transitioning that way because of Covid”. Dr. Dingley reflects that, “our eConsults were becoming this beast that we couldn’t manage any more, so we had to make into more of a system”.
Fordingbridge launched Anima in 2022, receiving all practice requests via the platform - whether that be submitted by patients online, or submitted on the patient’s behalf by a member of practice staff. Using Anima for total triage has meant that the practice can better prioritise what is needed for each patient case:
It means that we can promote continuity where continuity would benefit the patient the most, or speed or urgency if that’s the most important thing.
It also meant that they can use resources both in and beyond the practice to their fullest potential - whether that’s to a local eye service, an extended hours physiotherapist, or another member of staff at the practice. Tools like Anima’s MDT Hub are designed to help bolster this capacity even more, by enabling any authenticated users in the healthcare system anywhere to discuss a case under a single source of truth within 30 seconds:
Anima's MDT Hub in action
At the same time, offering digital triage can also empower patients with links to education and self-help, functions to select their preferred doctor, as well as allowing patients to access care without necessarily having to visit the practice. With Anima, practices using a total triage model can even submit requests on behalf of a patient if, for example, the patient doesn't have internet access or a smartphone to create their own Anima account. As the Fordingbridge team have found:
It’s becoming increasingly obvious that lots of practices are having to adopt this approach [total triage], and patients are definitely more accepting of this than they used to be.
How has online consultation and Anima helped you to successfully keep the model going?
The functionality and capability of Anima means that total triage has been far easier to implement and maintain than before according to Dr. Wallis:
Now we can reassign requests to a more appropriate person straight away, message the patient back for more information, get a photo...
Anima can help to automatically triage and allocate requests to members of the medical or admin team, with notes, clinical codes and patient communications automatically generated for practices and saved to the patient's record. Our newly released GP Connect integration means practices now have integrated access to the patient record and appointment booking, all from within Anima.
Having a full history to hand also enables staff at Fordingbridge to direct patients where appropriate to other points of care depending on their needs. This new way of working means Fordingbridge are regularly responding to upwards of 90 per cent of their incoming Anima requests on the same day.
We’ve got the time… we don’t have a scramble to the phones, or anything like "you have to have your Anima in by 9am, otherwise it’ll be full".
Especially by empowering their reception team to communicate the model with patients, and even be able to help submit patient requests on their behalf using Anima’s proxy requests, the practice team have found that total triage has bolstered their confidence in the care they're able to provide.
We feel like we’re providing a better service for our patients.
What advice would you give practice teams looking to keep - or adopt - a total triage model?
As with every system-wide change, it can be a tricky transition both for practice teams and patients. Dr. Hillsley advises practices to keep a positive attitude and ensure there is buy-in from the whole team: “the team needs to understand that it is for the patient”, and see how total triage can means that patients often get the right care they need the first time around.
The Fordingbridge team do emphasise that, “you need to accept that it is a different mindset”, and recognise that there will be a transition as you get used to the balance of managing incoming requests, and running appointments and other practice activity. The Fordingbridge team block a couple of hours a day to go through medical requests via Anima - and find “that it is enough time”, and using Anima to support their total triage implementation means they have more visibility and control over practice workflow.
Anima gives us a feeling of control, and means we can give more appropriate appointments to patients.
Key more than anything to successfully implementing total triage (or any new initiative!) is good communication: with your team, and your patients. If you’re thinking of implementing total triage, the Fordingbridge team suggest “keep communicating with patients alongside the changes, so you’re not having to come back and explain or justify why you’re doing what you’re doing”.
With the quality of care that Fordingbridge are able to provide, managing changes with their teams and patients has been one of the key ways to ensure success - and is something that Anima can help with, by engaging with patients and PPGs as part of introducing the platform.
While each practice is different, for many total triage can be a transformative model: but it takes careful planning, with the right tools at your disposal. We've helped plenty of practices get started with total triage from scratch, so if you’re looking to join Fordingbridge in adopting what could be the future of general practice, we’d love to join you on your journey.
How Anima can help your practice team with total triage
Book a demo to chat to us about how your practice is managing at the moment, and how total triage could work for your team.
We’re also offering 30 mins of free consultation time to any practice who needs help with anything online consultation-related: getting started for the first time, common challenges, helping implement changes with patients - we’ve seen it all and we’re here to help!