The operational planning guidance document published by NHS England – which sets out priorities for the year ahead – makes clear that NHS systems will be expected to ‘support practices to increase
significantly the use of online consultations, as part of embedding total triage’.
The document also suggests that NHS England believes some GP practices are not delivering face-to-face consultations – a suggestion that has been condemned previously by GPs as offensive, and which brought an apology from NHS England’s top GP late last year.
Total triage was adopted across general practice from March 2020 on the advice of NHS England as the pandemic forced practices to limit face-to-face consultations.
NHS England defines it as a model in which ‘every patient contacting the practice first provides some information on the reasons for contact and is triaged before making an appointment’.
Despite the shift towards delivering more consultations remotely, GP practices have continued to deliver large numbers of face-to-face consultations, with RCGP surveillance data suggesting that around one in three appointments are currently face-to-face.
However, the NHS England strategy document calls for NHS systems to ‘support those practices where there are access challenges so that all practices are delivering appropriate pre-pandemic appointment levels’. It adds: ‘This includes all practices offering face-to-face consultations.’
Both the BMA and RCGP condemned a letter from NHS England last year that suggested practices were not delivering face-to-face care. The letter was briefed to the media before it arrived with practices – and triggered what GPs described as a ‘demoralising media onslaught’.
Wessex LMCs chief executive Dr Nigel Watson told GPonline practices were offering patients access to face-to-face care – and warned that long-term use of total triage would not be workable for all practices.
His comments come just days after RCGP chair Professor Martin Marshall said that although triage – and remote consultations – had a role to play in general practice beyond the COVID-19 pandemic, it must be for GP practices to decide locally what works for their patient population.
Dr Watson said: ‘This has to be the starting point for a discussion. Total triage is workable for some, but is not what everyone will want.
‘Some people find it time consuming doing total triage. General practice is not one model – it is a number of different models – and this is not going to be a case of one size fits all. ‘
Dr Marshall told GPonline earlier this week that given the workforce crisis in general practice, some form of digital triage in future may be essential to manage workload – but was clear that models needed more evaluation and that the right solution would vary for different practices serving different populations.
NHS England board papers published earlier this week suggested that – including COVID-19 vaccination work – by the end of January this year general practice was delivering around 1m more appointments per week than at the same time in 2020.
Vaccinations accelerated over the following month, suggesting this figure may have risen even further – and could be an underestimate given that NHS Digital says its appointment data does not fully reflect telephone consultations.
The strategy paper says the success of the COVID-19 vaccination programme has proven ‘beyond doubt the value and potential of PCNs’ – and that all NHS systems will be expected to support the networks to expand the NHS workforce.
PCNs will be expected to continue to target 15,500 full-time equivalent (FTE) additional primary care staff by the end of 2021/22 through the additional roles reimbursement scheme, and to support progress towards the government’s target of increasing the FTE GP workforce by 6,000 – part of its promise to increase GP appointments by 50m a year.
The strategy document sets out plans to incentivise hospitals to work through the NHS backlog, to drive cancer referrals back to pre-pandemic levels
It highlights the continuing role practices will play in delivering COVID-19 vaccination to patients aged 18-49, and says NHS systems should be ready ‘for the possibility of COVID-19 vaccination for children’.