Mental Health and COVID 19

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How telephone triage is helping both workforce and patients during the Coronavirus pandemic

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Here at the GP Federation, like thousands of GP Practices up and down the land, we were quick to develop telephone triage and video assessment facilities as part of our Covid-19 resilience hub. In this blog, our Quality Clinical Lead, Dr Saveena Ghaie, talks about how telephone triage is helping both workforce and patients in Bolton during the coronavirus pandemic.

Over the past couple of months, there have been lots of quick changes to the way general practice runs, such as the use of telephone and video to assess patients.

Telephone triage has long been used by the medical profession to effectively direct patients to the most appropriate service. In recent years, with the introduction of the additional workforce of pharmacists, mental health and musculoskeletal practitioners within general practice, its use has become more widespread. But still, not all practices had been using it – until now.

The Covid-19 pandemic has forced all practices to use telephone triage. Doing this has allowed them to protect their patients and their workforce and, as patients can be screened for symptoms and then managed effectively without increasing exposure to others, it has been absolutely critical in reducing the spread of the virus. Many patients can in fact be managed entirely by telephone and the need for a face-to-face consultation is not required.

The move to a telephone triage system has been welcomed by many. For patients there are many benefits. It means no unnecessary travel to the surgery and they can be assessed and their clinical problem be managed more quickly than it would by a traditional appointment. For clinicians, it means a more effective use of available time and resources and the ability to deal with more patients.

Telephone triage is not without its disadvantages, however. Even using the advancing video technology, without the ability to examine the patient in front of them, clinicians have to deal with a degree of medical uncertainty and in some cases, there will still be a need to see some patients face-to-face. In addition, both clinicians and patients are concerned that this remote way of working may degrade the doctor patient relationship.

But whilst Covid-19 remains a threat, telephone triage is here to stay. And whilst all of Bolton’s practices are now set up in this way, it will very likely become more the norm, even beyond this pandemic.

The impact of COVID19 on Primary Care: Reflections on the last two months and what challenges lie ahead

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In this blog the Chair of Bolton GP Federation, Dr George Ogden, reflects on the last couple of months and looks ahead at what changes are to come.

Coronavirus or Covid19 has seen us make some unimaginable progress in just a matter of a few weeks, and in some cases, days. We’ve seen the relaxing of rules, the introduction of new processes and systems, new and different relationships, sharing new information and changing cultures across all sectors. We’ve also seen some major developments of new technology.  In Primary Care we were ahead when it came to IT and our well established and mature systems in Bolton meant we were able to quickly develop virtual consultations (by video and telephone), something that has become a hot topic for how patients access their GPs now and into the future.

We are, thankfully, starting to see less deaths and fewer people affected by coronavirus, and hearing more talk about the lifting of lockdown restrictions. And while we celebrate this (and we should) we in Primary Care cannot sit on our laurels as we are getting ready to hit some huge peaks of work.

From a clinical perspective, up to now it has been very much about managing Covid19 in the immediate and short-term. Contact tracing (where people who may have come into contact with an infected person is tracked down) is going to be vital to manage Covid19 going forward. This needs to be done on a wider than practice basis and we have a real opportunity here, with the resources in Primary Care, to improve neighbourhoods and networks by using these as trusted models for testing.

There is going to be a legacy of Covid19 that will see more people needing care from us – those who haven’t presented to us already as they’ve put it off during lockdown, those whose care has been interrupted or have developed complications, and those who have developed mental health issues. This means that while others are getting back to business as usual, Primary Care will be seeing a surge in demand, which we need to be prepared for.

At Bolton GP Federation we are working closely with practices to ensure we can support them in these times. For example, we have recently set up an Experienced Nurse Network so that practices can access important nurse capacity to help them with their workloads and to cover staff absence. And through Extended Primary Care we will provide further support to practices by offering bespoke clinics based on their patients’ needs.

A huge positive of Covid19 is that it has promoted relationships with our community colleagues, including our pharmacies and care homes, at a strategic level. Bolton GP Federation’s clinical pharmacists will be working with community pharmacists to build on these relationships and be there and ready to support our residents. We have always had these great relationships on the ground and having this can-do culture across the whole system and from the top, will allow us to learn valuable lessons and move on quickly, and for innovation to happen.

George Ogden

Chair, Bolton GP Federation