The 2023/24 GP contract includes a focus on improving patient access and optimising demand and capacity in general practice. AI triage tools have emerged as a promising solution to tackle these challenges.
It is widely known that there is a growing mismatch between supply and demand in primary care. With an ageing population and increasing numbers of patients with complex health needs, primary care providers are facing mounting pressure. Meanwhile the amount of GPs has declined steadily since 2017 accompanied by a burgeoning narrative of burnout and disillusionment amongst the profession.
The traditional model of first-come-first-served GP appointments booked by phone is buckling under the pressure.
The traditional model of first-come-first-served GP appointments booked by phone is buckling under the pressure. Patients face long telephone queues to talk to receptionists, only to be told to ring back the next day, or book an appointment in several weeks. This is resulting in an ever-increasing spillover into A&E departments and walk-in centres as patients turn to alternative NHS services to meet their needs.
In an attempt to combat growing public frustration regarding GP access the 2023/24 contract requires GPs to offer patients an assessment of need, or signpost them to an appropriate service, “at first contact with the practice”. Practices will no longer have the option of asking patients to come back later when appointments are fully booked. However, according to the BMA, the “majority of practices” will be unable to fulfill this without further investment in staffing and infrastructure.
There has been a push in recent years to introduce a new MDT model into primary care. This move is in recognition of the fact that there are not enough GPs to meet current demand and that many issues dealt with in GP appointments could be managed by other professionals. The additional roles reimbursement scheme (ARRS) has recruited over 25,000 allied health professionals into general practice including pharmacists, physiotherapists, physician associates, advanced nurse practitioners, mental health practitioners and social prescribers.
The growing importance of triage
For GP practices to manage patients ‘at first contact’ whilst also effectively using a range of new MDT ARRS professionals requires the introduction of a triage process. Triage involves sorting incoming requests so they can be appropriately assigned to different team members based on the patient problem and the clinical urgency.
Triaging appointment requests allows for different professionals to work ‘at the top of their license’ and aims to prevent GPs being overwhelmed by unnecessary appointments.
Many practices are currently meeting this triage need by assigning GPs to manually triage large volumes of incoming online consultation requests, using up valuable clinician time that could be spent seeing patients.
Automated triage tools
AI-enabled triage solutions like Visiba Care’s Red Robin can be used to automate triage in primary care. Red Robin’s triage system uses algorithms to question and analyse patient symptoms, medical history, and other relevant data, and provide possible diagnoses and an urgency score. It is possible to automatically assign cases to specific roles within a practice, including ARRS appointments. The asynchronous nature of these tools means that patients or carers can access primary care in their own time, confident that symptoms and concerns will be understood and interpreted to make the best possible use of available healthcare resources.
The adoption of these technologies has been encouraged by the NHS.
During the pandemic NHS England and NHS Improvement issued guidance to support GPs in implementing triage systems. This was followed in March 2021 by an NHS England strategy document that encouraged healthcare systems to embed triage in general practice post-pandemic.
Alongside access targets the 2023/24 GP contract contains QOF QI modules with an emphasis on using data to analyse potentially avoidable appointments and build on care navigation and use of wider workforce or local services to reduce pressure on General Practice. Data-driven triage solutions like Red Robin can also help to meet this need, offering intelligent appointment booking, effective service utilisation and improved patient care journeys.
Ensuring equitable access
Effective implementation of AI powered triage technology should not exclude anyone from accessing care or disrupt continuity of care in primary care. Introducing digital triage can help to free up practice phone lines and other forms of access to those who are not able to use digital tools. Urgent issues can be flagged and dealt with in a timely manner whilst continuity of care can be maintained and supported where it adds value to patients and clinicians.
For PCNs grappling with the implications of the new GP Contract, AI-enabled triage, coupled with a digital care platform to facilitate secure two-way communication with patients and ease administrative burdens could be a logical step forward. Helping practices and healthcare systems more effectively use existing staff and resources these systems can safely and efficiently manage patients accessing primary care.