The Institute of General Practice Management (IGPM) has urged NHS England and ICBs to pause GP contractual requirements around active triage of patient requests due to come into effect 1 October – until ‘safe working’ can be assured.
It is also calling for practices to be able to ‘opt out’ the triage requirement if there are no problems with their current model in meeting patient demand.
The new provision stipulates that the practice team should consider a patient’s ‘request for an appointment or medical advice and tell [the patient ] within one working day what will happen next’. It forms part of the patient charter that all GP practices will have to display from the start of next month.
Last month, GP leaders had raised concerns with NHS England about this wording, pointing out that it risked suggesting that patients should receive medical advice within that time frame.
Despite NHS England clarifying earlier this month that practices are not required to provide clinical advice to all patients ‘within one working day’ – it added that automated messages without active triage do not meet the appropriate response requirements and that blanket diverts to other NHS settings would also not be an appropriate response.
The IGPM has said it welcomes the clarification on clinical advice timeframes but has said it remains concerned about what is effectively, ‘the introduction of active triage as a contractual requirement, without adequate funding or workforce support.’
The IGPM’s five directors have warned it will place additional burden on practice managers, in particular, who are responsible for implementing new ways of working – as well as potentially undermine both patient safety and staff wellbeing.
Concerns are similarly shared by the BMA, RCGP and LMCs, they added.
They explained: ‘Practice managers and their front-of-house teams are already managing high volumes of demand, complex care navigation, and significant digital and reporting requirements.
‘Without additional investment in clinical and administrative capacity, the expectation to deliver these standards risks undermining both patient safety and staff wellbeing. We are particularly concerned about the additional burden placed on practice management who will be responsible for implementing these new ways of working.
‘Without proper recognition, protection and resourcing, this additional responsibility risks overwhelming non-clinical staff, increasing turnover, and further destabilising the safe running of practices’.
The practice manager organisation further pointed out that this new requirement ignores practices that have actively chosen ‘not to use a triage model and are able to manage access and demand and have positive patient feedback as a result’.
They added: ‘It is unclear what level of patient engagement has been undertaken, and whether these changes reflect what patients themselves value most in accessing their GP practice.’
The IGPM is now calling on NHS England and ICBs to:
- Pause this implementation until safe working is assured
- Provide dedicated and recurrent funding to support the triage requirement
- Acknowledge and address the workforce shortages affecting all parts of general practice
- Ensure that implementation of this requirement is safe, realistic and achievable, with appropriate system support
- Allow practices to opt-out of the triage requirement if there are no concerns about the practice’s current access model.
‘We are committed to working collaboratively with NHS England to find solutions that protect patients and staff, while ensuring general practice remains resilient and sustainable,’ IGPM directors emphasised.
