STEP 1

Agree date

With all of the above in place it is possible to go live. We suggest you do not go live on a Monday or a Friday, and also that you have someone experienced to ‘walk the floor’ and trouble shoot and support.
STEP 2

Final comms

  • Create a patient leaflet: include online prescriptions and letters/reports.
  •   Send a text message to all the practice patients.
  •   Change practice voice mail message – in the voice of the most senior person.
  •   Include in practice welcome pack for new patients.
  •   Advertise: in practice newsletter, on practice website, social media, NHS Choices.
  •   On day one, clinician by the door and the phones.
STEP 3

Final planning

Ensure more than adequate staffing for day 1

Have someone to walk the floor – to troubleshoot and support people

Check everyone knows their roles and responsibilities

STEP 4

Top tips

  • Team top tips
    • Signposting is critical to whole process flow.
    • Duty roles – duty should be fun! Duty admin/GP/nurse are there to make the triage list work get done smoothly.
    • Start each session with short huddle: who is here? Any live problems? What are we testing this session?
    • Physical location of the team is important to help with supervision and efficient use of people resource – ideally use rooming: admin and clinical in one room.
    • Really use skill-mix and get everyone involved working at the ‘top of their license’. (to their fullest potential?)
  • Process top tips
    • Minimize handoffs and over-processing.
    • Agree number of callback attempts – ideally two, then send an AccuRx/email asking patient to call back if still needed.
    • Agree what problems constitute clinically URGENT e.g. chest pain/new onset short of breath/suicidal repeat.
    • All doctors to aim for a standard level of activity per triage session around 25-30 patient contacts (telephone/video calls; face-to-face; eConsult), pro rata for part session. This is a level of activity to aim for, it is not expected or necessarily desirable that all doctors will achieve this level immediately or consistently.
    • Usually (in non-COVID times) there should be no more than three face to face appointments booked in advance on each triage doctor session – this includes booked by that doctor as well as booked by others. Any more than this and the triage system grinds to a halt.
    • Try not to pre-book call-backs in advance, ask the patient to call back or submit an eConsult on the day that they need it.
  • Patient top tips
    • For vulnerable or discretionary patients needing a proactive call or review, book this on triage session on the appropriate date with doctor’s name clearly in slot properties.
    • If you fail to contact a patient, document ‘failed encounter’ in the clinical history (not problem title) of the consultation. Attempt to contact each patient twice (or more at the discretion of the clinician e.g. if a vulnerable patient).
    • If a patient has been spoken to previously about the same problem, then strongly consider if they should be seen face-to-face.
    • Encourage continuity of care. Patients will make a trade-off themselves between speed of access and continuity. Inform patients when their usual doctor is in and consider giving out business cards (or AccuRx template) as a reminder.

Well done – you now have a functioning total triage system!

It is important  now that you continue to monitor it, to improve it and respond to changes, which is detailed in the next stage.

STAGE 5 – Triage team set up
STAGE 7 – Monitor & respond