England GPs must offer face-to-face appointments from May 17 bringing an end to ‘total triage’

All GP practices must offer face-to-face appointments and an in-person reception desk, NHS England has said, bringing an end to the mandatory “total triage” system introduced during the pandemic.

In a letter sent out on Thursday, GPs were told the use of telephone and online consultations can remain where patients benefit from them, but physical appointments must also be available from May 17.

All practice reception desks must now be open to patients, in a Covid-safe manner, so those who do not have easy access to phones or the internet are not disadvantaged when accessing care.

What is total triage?

Total triage was a system whereby patients were remotely screened and directed to the most appropriate health service for their problems, and was introduced as a Covid-19 precaution.

GP appointments were also conducted by telephone, video or online unless it was clinically necessary for a consultation to take place in person.

Currently around half of consultations in general practice are being delivered face to face.

Before the pandemic, some 70% of appointments were face-to-face and 30% were phone, video or online, but this switched to around 30% face-to-face and 70% remote at the height of the crisis.

‘Patients’ preferences must be respected’

In the joint letter from Dr Nikki Kanani, medical director for primary care at NHS England and director of primary care Ed Waller, doctors were told patients’ preferences must be respected.

“Patients and clinicians have a choice of consultation mode,” they said.

They added: “Patients’ input into this choice should be sought and practices should respect preferences for face-to-face care unless there are good clinical reasons to the contrary.”

Dr Kanani and Mr Waller cited the presence of Covid-19 symptoms as an example of a reason to refuse a face-to-face appointment.

“Patients should be treated consistently regardless of mode of access,” they said.

“Ideally, a patient attending the practice reception should be triaged on the same basis as they would be via phone or via an online consultation system.”

Dr Kanani and Mr Waller added that to ensure receptions can open safely, patients might be asked to queue outside.

The letter to GPs comes just two days after a report by the Royal College of General Practitioners (RCGP) heavily criticised plans to embed total triage into general practice post-pandemic.

The report noted that complex conditions or those of a sensitive nature where a GP might need to pick up on non-verbal queues such as signs of anxiety or indicators of substance abuse can be easily missed remotely.

Professor Martin Marshall, chairman of the RCGP, welcomed the news that the option of in-person services should be available to everyone.

He said: “This is good news and is what patients and GPs want to see. It removes ambiguity and we are particularly pleased that our calls for shared decision-making between GP and patient on the most appropriate method of consultation have been heard.

“We now have a flexible approach decided upon by clinicians and their patients.”