Total Triage Model in General Practice: A Systematic Review of the Opportunities and Challenges

Increasingly, remote consultations are used within General Practice. This is a consequence of numerous factors including pandemic adaptations to appointment systems and the societal movement from personal to digital interaction. These have resulted in the development of the Total Triage Model of Appointment management. In addition to the pandemic, in recent years, there has been increasing pressure within general practice. With a decrease in general practitioners (GPs), population growth, increasing prevalence of chronic conditions, and appointment demand. Despite Government initiatives to recruit 6,000 more GPs in February 2020, the BMA has noted a real loss in full time equivalent hours of 1,808 GPs since September 2015. In the same period, the patient caseload has increased with practice’s having an average of 2,131 more patients. It has been noted that there has been a shift in GP workload with more need and demand for GPs to be completing administrative work, which often there is not scheduled time in their sessions for. Increased clinical and administrative workload has been identified as a key reason for leaving and / or intention to leave among GPs. Total Triage became critically important during the COVID-19 pandemic and in general practice, remote consultations increased from 14.7% in February 2020 to 48.1% in April 2020. Although this has now dropped to 28.5% as of September 2022. This major change within the traditional structure of general practice has been linked to workload shifts between staff, from GPs to practice nurses. Rapid changes such as this have stimulated differing opinions among key stakeholders. The NHS has stated that clinicians should offer Face to Face Appointments without prior Triage. However, research has found that patients value having the flexibility of remote consultations. The aim of this systematic review is to examine and configure the available literature about the implementation of Total Triage, the reported opportunities and challenges for patients and staff and further implications for patients and practices.