By Dr Sonal Shah – GP Partner, Manor View Practice
Nearly three years ago, we made a significant change to how appointments are organised across our surgery. We introduced Total Triage.
We understand that for some patients this system can feel frustrating. Completing a form instead of booking directly may feel like an extra step. Some people worry it creates a barrier.
We want to explain clearly why we made this change, how it works, and how it benefits both patients and the practice.
What Was Happening Before?
Before Total Triage, appointments were running out very early in the morning. By 8:30–9:00am, many same-day appointments had already gone.
This created two serious problems. First, urgent patients were not always being prioritised appropriately. Second, clinicians were working under unsafe pressure, reducing the time available for each patient.
When we analysed our data carefully, we found:
- Patients who could safely have been managed on the telephone were being booked into limited face-to-face slots.
- Patients who genuinely required examination were sometimes unable to secure an in-person appointment.
- Members of our wider clinical team were not always being used to the full extent of their skills.
At the same time, general practice operates within a fixed NHS funding envelope. Demand, complexity and patient numbers have all increased significantly. Funding and workforce numbers have not risen at the same pace.
National guidance, including advice from the British Medical Association, recognises that there is a safe limit to the number of clinical contacts a GP can manage in a day. Beyond that, patient safety can be compromised.
We realised we needed a safer, fairer and more sustainable system.
What Is Total Triage?
Total Triage means every clinical request is reviewed clinically before an appointment is allocated.
Patients complete a short form explaining:
- What the problem is
- How long it has been going on
- What they are worried about
- What they are hoping for
Digital access is not a barrier to care. If you are unable to complete the form online, our reception team will complete it with you over the phone.
Using the information provided, a GP partner or senior GP decides the most appropriate next step. This may include:
- A same-day GP call
- A routine GP appointment, either telephone or face to face
- A same-day face-to-face GP appointment
- An appointment with a nurse practitioner or paramedic
- Referral to a community pharmacist under the Pharmacy First scheme
- An appointment with a first contact practitioner, mental health worker, link worker, nurse, pharmacist or other allied healthcare professional
- Advice, safety-netting, prescriptions or administrative support where appropriate
- Referral to minor injuries services or advice to attend A&E where necessary
Many of these clinicians are highly trained specialists in their own right. They are able to assess, diagnose, prescribe and refer appropriately. The triage process ensures you are directed to the right professional safely and efficiently.
What Has Changed?
Since introducing Total Triage:
- Appointments are now available throughout the day, often until 4:30–5:00pm, rather than disappearing early in the morning.
- Around 40% of requests can be safely managed without a face-to-face appointment, protecting in-person capacity for those who genuinely need examination.
- We are able to see more patients overall each day because care is allocated more appropriately.
- Clinicians are no longer working under unsafe concentration of demand in a short time window, allowing safer, more focused consultations.
We operate across four sites. This allows us to review capacity across the whole organisation rather than each site functioning in isolation. If one site is full, there may still be availability elsewhere on the same day.
We understand that travelling to another site may feel inconvenient. However, the benefit is often same-day access rather than waiting longer for a specific location. Patients can always choose to wait for their preferred site if it is clinically safe to do so.
This shared-site model allows us to use our full workforce effectively, maintain access across the day and prioritise urgent care appropriately.
The result is a more stable and sustainable system.
The Scale of the Work
Each week we review approximately 2,800 clinical requests.
Our triage system is supported daily by 4–5 GPs, supported by our lead receptionists and wider reception team. Every request is reviewed carefully and clinically.
We are working at full capacity every day to ensure patients receive appropriate and timely access.
Why This Benefits Patients
Total Triage helps ensure:
- Patients who need examination receive face-to-face care in a timely way.
- Minor illnesses are managed quickly by the most appropriate clinician.
- Urgent issues are identified early and prioritised correctly.
- Simple concerns can often be resolved the same day without attending the surgery.
- Face-to-face appointments are protected for those who genuinely need them.
This system also removes the need to compete at 8:00am for limited slots. Requests are reviewed based on clinical need rather than speed of dialling.
We value continuity of care and will accommodate clinician preferences where possible. However, many doctors work part-time, and urgent issues are often safer to address promptly rather than waiting for a specific individual.
Total Triage balances access, safety, continuity and fairness.
We Understand the Frustration
Change can feel uncomfortable.
Some patients prefer booking directly. Some feel they are “justifying” their need for care. That is not the intention.
The purpose of the form is to gather enough clinical information to ensure you are directed to the right person, in the right way, at the right time.
Without triage, appointments would continue to disappear early in the morning and urgent cases could be missed.
The Wider NHS Context
General practice is currently managing:
- Increasing patient numbers
- More complex long-term conditions
- An ageing population
- Significant workforce pressures
- Funding that has not kept pace with demand
Demand for GP appointments has risen substantially across the country. The number of full-time equivalent GPs has not increased proportionately.
There are ongoing national discussions between the Government and the British Medical Association regarding contracts, workload and funding. These discussions reflect the real pressure general practice is under.
We do not have unlimited appointments, funding or workforce. Our responsibility is to use the resources available to us in a way that is safe, fair and sustainable.
Total Triage is one way we are increasing access while maintaining safety.
Demand for GP appointments has risen substantially across the country. The number of full-time equivalent GPs has not increased proportionately.
There are ongoing national discussions between the Government and the British Medical Association regarding contracts, workload and funding. These discussions reflect the real pressure general practice is under.
We do not have unlimited appointments, funding or workforce. Our responsibility is to use the resources available to us in a way that is safe, fair and sustainable.
Total Triage is one way we are increasing access while maintaining safety.
How You Can Help
As our most important stakeholders, patients can help the system work effectively by:
- Providing as much detail as possible on medical forms
- Uploading clear photographs where appropriate
- Letting us know if this is a recurring or previously assessed issue
- Being clear about what outcome you are hoping for
This information allows us to make safe, accurate decisions.
Our Commitment
We regularly review our data, patient feedback and clinical outcomes to ensure the system is working as intended. Where something is not right, we review, analyse and adjust within the resources available to us.
Total Triage is not about reducing care. It is about increasing access and organising care more intelligently so that those who most need to be seen are able to be seen.
We are a dynamic practice. We continue to innovate and improve for both patients and staff. A supported clinical team delivers better care.
We will continue to listen, review and evolve.
If you would like to contribute to how we shape services, we welcome new members to our Patient Participation Group.
Patient care remains at the heart of everything we do, and we are proud to serve our community.
