Beyond Total Triage



myGP® is the UK’s largest independent patient facing service.

While the overall transaction volume on the platform more than doubled from 12 million transactions in February to 27 million in March, bookings and cancellations on myGP almost halved (down 42%). The main reason for this rapid reduction was that GP practices around the country followed NHS guidance to switch off online booking and “triage” all patients to avoid practice visits during the Coronavirus crisis.

Raising barriers to primary care may have been the right (or only) choice as a short-term measure, but is ‘Total Triage’ the right model as we emerge from lockdown?

The primary issue with Total Triage is that it makes for a singularly underwhelming patient experience. The result of this mandate is that – from both patient and practice – accessing primary care is now anything but simple.

Consider, for example, that pre-Coronavirus, roughly half of all appointments were used by patients who have been told to see a doctor – often by the very clinician that they have had an appointment with. These appointments include medicine reviews, follow-ups, regular tests and check-ups. Triage for these appointments does little more than add unnecessary steps for both patient and practitioner and it raises barrier to accessing healthcare.

More recently, few (if any) patients visit their GP practice in person. The default consultation model is remote, via phone or video. Unfortunately, some appointment types do not lend themselves well to video or telephone and are therefore unsustainable beyond Covid-19 lockdown when we will move to find a more optimal balance between physical and virtual visits.

So, as we emerge from lockdown how do we avoid unnecessary appointments, collect the right patient data prior to appointment to optimise the consultation AND provide a good patient experience?

Here are a few places to start:

  1. Allow online booking for remote consultation appointments with enhanced data capture

All practices should switch online appointment booking back on, “unlocking” this electronic capability for those whose requests defaulting this option to telephone or video consultation. Implement exception-based triage for physical appointments and inform patients of the switch using messaging.

  1. Implement online booking without triage for invited patients

With seasonal flu immunisation just around the corner, use your GP principal system to identify ‘at risk’ patients and invite them for short immunisation appointments bookable online but without unnecessary requirements on triage. This model of streamlined engagement can be expanded to other services including cancer screening, health checks and childhood immunisation.

  1. Implement intelligent care navigation  

Intelligent care navigation helps reduce unnecessary appointments by signposting patients to pharmacy services, other care professionals, or relevant information before an appointment request is made (and a triage form is required). A truly intelligent care navigation system will also identify appointments with specific data requirements (text/forms, graphs, pictures and videos) and request submission of these prior to confirming an appointment.

We are working hard to ensure our practices are equipped with the tools they need to best manage primary care in the current climate. We want the myGP platform to be flexible enough to support any care model and include best practices tools such as eConsult. Our Triage solutions go part of the way toward a brilliant patient experience, whilst also saving time and effort within GP practices.

We will graduate out of a Covid-19 world with a balance between on and offline care, with a new appreciation that many consultations can be conducted remotely. Healthcare professionals will have found that it is feasible at times to work from home. We will have a greater appreciation for the work healthcare professionals do day in and day out to keep our population healthy.

This paradigm shift will encourage even greater uptake of ‘digital-first healthcare’. Let’s prepare for this inevitability by, well… keeping it simple.

Stay safe!

Tobias Alpsten

CEO, iPLATO Healthcare, creators of myGP