STEP 1

Agree roles & responsibilities

They key people in the process are the reception staff (patient assistants), the duty team and the clinical team. Each has specific roles and responsibilities which need to be clearly understood. A brief summary is as below:
  • Patient Assistants:
    • Assign calls to the registered or most appropriate doctor by adding a comment under the slot. It may be that the patient is being cared for by someone different from their usual doctor, in which case he/she will express that preference
    • Assign presentations to the correct member of staff to manage these
    • Communicate expected response times to the patient
    • Action all ‘Admin triage’ slots on the triage list
  • The Duty team:
    • Reviews the triage list to confirm appropriate clinical allocation
    • Monitors how calls are going and makes a judgement around whether it is necessary to move to urgent calls only
    • Duty GP ensures all calls are closed off at the end of the session
    • Duty GP is the initial contact for nurses, district nurses, health visitors etc.
    • Duty GP supervises trainees and Physician assistants if relevant
    • Duty Nurse picks up contacts suitable for Nurse traiage
    • Acts as point of contact for activities related to triaging e.g. urgent ECG or nebulisers needed.
  • Clinicians:
    • Work through the list and manage people as appropriate.
    • Book any face to face appointments as needed.
    • Note that there is no cut off time for calls to be returned on the day. All calls received on the day are returned on the day.
STEP 2

Training – signposting

STEP 3

Triage team trial runs

  • For signposting you need to know what skill mix you have and what those people can deal with. We have examples of this in the EQUIP manual which will help you. We also have a useful scrip for patient assistants to use to establish the reason for the call.
  • Duty Team – the EQUIP manual describes the members and roles – you can use this as a guide – clarity over the role of the Duty team is important. Location is also important – co-location helps with team work but this may have to wait. There is a lot more detail in the EQUIP manual. A daily huddle of the Duty team at a minimum is also very helpful for planning the day. More detail in the EQUIP manual.
  • Clinical Triagehere the clinician makes a decision on how to manage the patient – be that an email, AccuRx message, phone call, video call, or a F2F appointment. This is something most practices are now used to! You need to have the right equipment in place for this.

Explore all of the above and if a decision is made to proceed then go on to:

STAGE 4 – Practice set up
STAGE 6 – Go live