The Wilmslow Health Centre Triage System

What is The Wilmslow Health Centre Triage System?

The Wilmslow Health Centre Triage System was developed by GPs at Wilmslow Health Centre during the Covid Pandemic to facilitate more efficient handling of the ever rising demand for primary care appointments. The system uses Patient Triage supplied by AccuRx as the online patient communication platform and relies on the triaging skills of experienced GPs to prioritise resources according to clinical need as well as signpost patients towards the most appropriate services.

This system has also enabled the practice to work toward implementing the BMA’s Safe working in General Practice guidance to ensure Primary Care teams provide patient appointments more flexibly, direct patients to the most appropriate provider of care and prioritise care for those most in need.

Feedback from patients has been overwhelmingly positive and NHS digital statistics show that we delivered an extra 15k appointments last year than in 2019. NHS digital data shows that in 2022, we delivered 63,000 appointments (93% of them face-to-face).

How it works

Patient submits an online submission using a simple online form

• We have tried numerous online consulting platforms and have settled with AccuRx’s Patient Triage solution because out patients prefer its simplicity and the ease with which submissions can be made to the surgery.
• We also found that the system integrated with our clinical system (EMIS Web) much better than other systems and with less chance of error.
• The system is fast, smooth and reliable with minimal downtime and excellent user support.
• Admin staff and triaging clinicians also prefer the intuitive user interface and the ease with which submissions can be read and acted upon.

• Whichever online system you choose to use, it is important that practices are able to switch off the ability for patients to submit a form especially during evenings, weekends and bank-holidays. Our conclusion has been that demand in the NHS is actually unlimited and NHS healthcare is essentially rationed. Traditionally the mechanism of rationing was via wait times on telephones and in queues at GP reception. This method of rationing and limiting demand is bypassed by online patient submission platforms and threatens to overwhelm already limited primary care resources so mechanisms to switch off online submissions are essential.
• Those patients genuinely incapable of using the online form are still able to call the surgery to access care. Receptionists (Care Navigators) complete the online form for the patient and the request is triaged along with other forms submitted by online users. AccuRx Patient Triage allows Care Navigators to submit such forms on patient’s behalf very easily into the main triage workflow.

Patient submission enters the Triage Workflow

• All online submissions enter the “To Assign” inbox of the AccuRx Patient Triage system
• The “To Assign” inbox has two subfolders; “Admin Queries” and “Medical Requests”.
• A Care Navigator checks the submissions in both of these subfolders and forwards the appropriate clinical requests to the “Clinical Triage” folder for the Triaging Clinician’s attention.
• Queries not requiring the attention of the Triaging Clinician are forwarded to appropriate team folders (eg. Secretaries, Receptionists, etc). Such folders can be configured to suite the practice within the AccuRx Patient Triage Control Panel.

Submissions are triaged by a Clinician

• We have found that triaging is best done by experienced GPs. Whilst this takes away a GP from a booked surgery list, we have found that slots are triaged and dealt with much more efficiently and wait times for appointments have actually decreased from what they used to be before we implemented this system.
• On-call clinicians cover either the morning or the afternoon session. Our morning session runs between 8AM and Noon. Our afternoon session runs between Noon and 6:30PM. We are considering having two triaging clinicians on Monday mornings as demand is so high during this period.
• AccuRx Patient Triage allows the Triaging Clinician to request further information directly from the patient who has submitted a request. Requests can also be made for photographs or copies of any relevant documentation.
• The on-call clinician diverts as many requests as appropriate to other locally commissioned services such as First Contact Physiotherapists, Community Pharmacists, Care Navigators, etc.

RAG Rating

• The Triaging Clinician categorises requests requiring primary care appointments into Red, Amber and Green appointments.
• Patients requiring Red appointments are seen that session. It is important not to assign patients into Red Appointment slots for later sessions. Red Appointment slots across the practice are limited and once the Triaging Clinician has used up Red Appointment slots for their on-call session, any further appointments categorised as Red during that session will be seen and addressed by the Triaging Clinician. This incentivises the Triaging Clinician to use Red Appointment slots appropriately and to deal with any minor episodes themselves in order to preserve as many Red Appointment slots across the practice.
• Amber Appointment slots (sometimes subcategorised into Amber 1 (to be seen within 1 week) and Amber 2 (to be seen within 2 weeks).
• Green Appointment slots are for those patients whose needs can wait until the next routine appointment.
• RAG rating requests for care needs careful preparation and thought. We are tweaking our appointments and the proportions of each type of appointment constantly, often resulting in wait times for green appointments increasing. This way of triaging does however ensure that care is prioritised according to clinical need more safely.

Patients are sent self-booking links

• AccuRx Patient triage allows patients to book in for appointments directly on-line.
• Whilst initially this worked only for telephone appointments, AccuRx Patient Triage now offers the ability to send booking links for ANY type of appointment category configured on your clinical system. By default, all out appointments have been Face-to-Face for the past 18 months.
• A booking link is texted to the patient and the patient can choose from a number of appointment options at their convenience.
• Appointment slot types (Red, Amber and Green) need to be configured on your clinical system in order for the correct type of appointment to be offered to the patient by text
• Care Navigators contact patients directly if they are unable to use text messaging or unable to navigate the online booking system.

What the Wilmslow Health Centre Triage System is NOT

The Wilmslow Health Centre Triage system is NOT a solution to the growing recruitment and retention crisis facing primary care in the NHS. No triage system can solve the severe capacity challenges that UK Primary Care continues to face due to years of underfunding and ever rising demand for healthcare in a free-at-the-point-of-delivery healthcare system. Various governments over the past 20 years have tried to impose various access and triaging schemes onto primary care with limited success as they have failed to address the fundamental issues of limited primary care capacity and unlimited patient demand and we remain skeptical of anyone who thinks that technology or new ways of triaging alone can solve the growing problems faced by patients trying to access the limited capacity of primary care.