The latest delivery plan for primary care released by NHS England promises to tackle access, putting an end to the 8:00 AM stampede and making it quicker for patients to get the help they need from primary care.

But does their plan stack up or is it just more hot air? Let's take a closer look:

First of all, let’s be clear. Everyone working in general practice in England knows that general practice does not have an access problem, it has a capacity problem. An access problem would suggest there are lots of free appointments if only you could get people into them, when clearly, that’s not the case. 

There are plenty of appointments (36.1 million appointments were estimated to have been delivered by primary care in October 2022 according to NHS digital) but they’re all full. 

This is driven by increased demand from patients, increased medical needs as a result of demographic changes and by staff voting with their feet and moving to greener pastures on the other side of the world thanks to chronic underinvestment in general practice.

So with that said, let’s take a closer look at the plan:

Does the plan bring new money? 

Reading through the 45-page plan it looks as though there is a lot of promised resource….but on closer inspection it’s money that was already promised to the service in other guises that has been relabelled. In reality, there looks to be precious little in the way of additional offerings.

Will the plan cut bureaucracy? 

This is something that has been attempted by organisations across the service from the BMA to individual GPs writing angry letters to hospital when they are treated like a community SHO with only small gains to show. 

If they can really make good on this promise and go further, it would make a clear difference to staff and patients alike. It talks about increased self-certification, improvement of self-referral pathways and allowing the onward referral from consultants to their secondary care colleagues.  

This has the potential to reduce the administrative burden, the number of contact points and improve productivity. 

The plan also states that NHSE are insisting that ICB’s will be tasked with helping address interface issues between primary and secondary care and within secondary care making the journey more seamless for patients, so it looks more linear and less like a spider on amphetamines. All good news

Personally, I’ll be looking at improvements our practice can make to its use of digital technology to communicate with our patients, and as the patients' access to their medical notes gets pushed through, look at ways this can be embraced to reduce our workload.

So - finally - the piece of this report that most caught my eye however was, (as you will guess if you've read my other posts), the implementation of “modern general practice access” section of the document.

Let’s focus on this for the rest of this article.

In short the proposal contains 3 key elements: cloud telephony, the NHS app and total triage. 

* The cloud telephony system had already been promised, but will no doubt improve certain aspects of life for both patients and staff with shorter wait times on the phone, offering to call patients back when they reached the top of the queue and integrating with our clinical systems allowing our reception teams to get to the patients notes more straightforwardly.

* Apps are being proposed as a ‘digital front door’ to primary care, especially the NHS app which may also be a useful tool for us in some cases.

* Finally, a total triage system (if you like a diagram see page 20 as that sums it up).  Now we’re getting somewhere.  At first glance it looks similar to the system that really does have the potential to improve general practice.

Buuuutttttt…..when it comes to effective triage, ask any A&E consultant and they’ll tell you it’s a mistake to assume it’s a basic function that can be taught quickly and easily to anyone. The idea that you can put the “cheapest” member of the team in this position and give them a basic map is a seductive trap into which many have fallen…

What is triage?

Triage was popularised in the First war to rapidly segregate casualties into those who needed urgent help, those who could wait and those who were so likely to die it was better to use the limited resources elsewhere.  The principle holds true today, but this kind of triage only has 3 simple outcomes.

Where you are dealing with only 3 possible outcomes, the task can indeed be devolved efficiently to a non-clinical team member with appropriate training and practice.

In contrast, modern general practice  involves the coordination of multidisciplinary practice teams with different skills and limits.  Total triage therefore involves the ability, without seeing the patient, to determine who needs urgent care, who needs routine care, who needs continuity,  who, as a quick task can be dealt with immediately  and who can be safely reassured triage, but also BY WHOM. Triage as applied to modern primary care, only becomes truly transformative when you put the most qualified clinicians at the front door.

In general practice, a non clinical navigator who is aware of what various community services are available to your patients, and who may even be able to direct your patients to the most appropriate member of your own team will lead to some improvements.

The biggest gains however only come when you put your most experienced person at this key first stage of the care navigation process.

When there is no more capacity or resource being offered, the only thing we can do is to increase our effective capacity by more efficient use of what we already have. Experienced clinicians who can get each member of the team working at the top of their licence can do this.

If you get behind this idea, the biggest advantages that come from using your senior clinicians at the front door are transformative –

·     Effective targeting of the patient to the best clinician first time

·     Quick reassurance of appropriate patients preventing any further contact - not possible with non clinical signposter

·     Development of new pathways to manage care in a more streamlined way that couldn’t happen without the GP being there.

·     More effective use of digital tools such as Accurx

Getting a clinician led system embedded is also less prone to falling apart if one member of staff chooses to leave or is otherwise unavailable - something that taking time to train up administrative staff into this role is prone to.

There can be plenty of barriers to getting to a system like this, from practical concerns such as space, worries over taking the leap and “sacrificing” appointments from the clinician taking the triaging role and getting the team on board with the change. But leaping these hurdles pays such dividends they have to be jumped!

I am excited to say that for anyone feeling they would want to take this journey but need a helping hand, the Clinician led total triage launch pad is taking off in the next couple of weeks. It will guide you through the steps of developing your own triage system and has regular drop in sessions with me to coach you and your teams through the change and get you working in this exciting new way..

If you are interested in joining this on its launch I will be sending out a launch email with initial offer to all the subscribers to my newsletter so if you are not already signed up, sign up here:

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