I work as a sessional GP in Essex and the medical director for Cambridgeshire and Peterborough local medical committee, and as such I have an immediate, and a system-wide view of where we are in general practice.
What those views tell me is that we are in a crisis: indeed, I’ve been a GP for more than 15 years and have never known it be so challenging, so exhausting and so difficult to provide the sort of care I trained to do, which patients deserve.
Each day seems to be about fire-fighting and uncomfortable compromise, further contributing to the stress GPs face.
To mark stress awareness month, I am writing the first, in what I hope will be a series, of bite-sized blogs on the theme of safer working. As a member of GPC, I’ve been glad to share the BMA safer working guidance to colleagues in my roles and now I want to look at individual aspects of this guidance and explore how real-life practice can stem from it.
For this blog I will focus on the topic of triage. As the safer working guidance puts it:
Remote consulting and triage are safe and effective ways of delivering care. Utilising these methods may allow practices:
- to provide patient appointments more flexibly
- direct patients to the most appropriate provider of care
- prioritise care for those most in need.
With the news that the impending contract imposition is going to require us to assess need for every contact made each day, triage systems are going to become increasingly important.
It’s not yet clear if this requirement is even achievable for us, but we also know GPs will be faced with patients armed with the news of this change, so the tide is coming regardless.
As well as fighting to challenge the governments contract imposition, the BMA has developed a care navigation/triage tool to support general practices in implementing a tailored triage system if they wish to do so.
One system that’s been put in place to good effect is found at a practice in Cheshire. The Wilmslow Health Centre Triage System uses AccuRx to triage every contact that comes to their surgery, and I spoke with Amar Ahmed, a GP at Wilmslow, recently about their system.
As he remarked, this is perhaps not how we would wish to run our practices in a perfect world, but we need to all bear in mind that we are where we are, and systems need to be safe, robust, and pragmatic.
Their system, designed and implemented during the pandemic, marries the IT solution offered via AccuRx with the clinical experience of experienced GPs, and I would recommend all reading this to look at the link for the details of how such a system can work.
Other online triage systems such as Footfall have their enthusiastic adopters, of course. We are also seeing greater use of trained care navigators, and experienced reception staff, to manage the deluge of calls each of us deals with every day.
And it is a deluge; the demand for care is essentially unlimited. A colleague has told me his surgery of more than 7,000 patients, on last assessing, saw 6,700 calls for 30 days. That averages out as more than one call every two minutes.
As I move on with this series of blogs, we’ll be looking at ways to reduce and redirect that demand, but essentially all of those will start with how we triage. It’s vital for all practices to adopt a safe, practical solution to do so – and doing that is entirely within our contractual obligations.
I’d love to hear from colleagues at [email protected] for ideas about future articles, and also to hear stories of good practice or advice for colleagues.
James Booth is a member of the BMA GPs committee