Improving patient access to primary care through a nurse triage system.

Problem

A General Practice workforce crisis is emerging, with fewer medical professionals training as General Practitioners (GPs) and more GPs working part-time and planning to retire early. This is particularly problematic in Powys, with 80% of current GP partners over age 50 and poor uptake of new GP positions. Optimising the workforce, by changing the way that primary care services are run, could help to resolve the imbalance between GP supply and demand. Use of the nurse triage system in primary care means that only patients who need to see a doctor are seen by the GP, whilst the rest of the patients have their needs met accordingly by other healthcare professionals or services.

Approach

Nurses at the GP practices used the Egton Medical Information Systems (EMIS) Web clinical system to conduct the triage process. An EMIS clinical template was created for the nurses to capture data in the clinical system to log the type of triage, consultation and outcome. From this, an EMIS Web report for triage appointments between December 2015 and November 2017 was used to review the South Powys cluster Nurse Triage pilot, and an EMIS Web report for between March 2017 and October 2017 was used for reviewing Total Nurse Triage. These reports were used to identify:

» The number of triage appointments where the EMIS clinical template was used.

» The type of triage encounters.

» Clinical outcome of the triage encounter.

» Manual collection of the clinical outcome of each triage consultation if the nurse did not use the EMIS clinical template.

» Age and sex of patients accessing both of the nurse-led triage services.

Findings

Less than half (45.47%) of triage encounters were referred on for contact with the GP, resulting in avoidance of 13,113 GP appointments over the pilot period. The remainder of patients were offered advice, a prescription or sick note, an appointment with a nurse, a referral for further care or an immediate referral to emergency services. The Total Nurse Triage system was also effective in reducing GP routine appointment waiting times and identifying clinical priorities to be seen urgently.

Consequences

Demand on GPs is reduced by referring patients to GPs only when necessary, and otherwise meeting patient needs through alternative service provision. Patient clinical outcomes data from a two-year pilot were used to evaluate the nurse triage systems. Benefits of the system are:

1. Patients can access immediate support from a nurse, including advice, prescriptions or referrals, without having to wait days/weeks for a routine GP appointment.

2. Reduced pressure on GP services, resulting in shorter waiting times for patients and GPs having more time to dedicate to patients with more complex needs.

3. Total Nurse Triage can identify high-risk individuals who need more urgent attention than a routine appointment, and refer patients for immediate attention where necessary.