North London Partners in health and care

Pharmacist-led telephone triage system reduces face-to-face contacts for urgent on the day appointments by over 50%


A pharmacist-led telephone triage system piloted by St John’s Way Medical Centre (SJW), in Islington, has reduced face-to-face contacts for urgent on the day appointments by over 50% in the first three months. Patients now are either managed entirely on the phone without the need for a face-to-face GP appointment, or are signposted to an alternative service such as a community based health provider. Initial feedback from patients and staff has been positive.

Jack Johnson-Rose, SJW practice manager and project lead, and Amira Shaikh, clinical pharmacist, explain the reasoning behind the pilot.

“Employing clinical pharmacists in GP practices means that GPs can focus their skills where they are most needed, for example on diagnosing and treating patients with more complex conditions. This helps GPs to manage the demands on their time. Previous pilot studies conducted by NHS England have demonstrated clear and encouraging benefits of practice-based pharmacists in reducing work-related pressure on GPs whilst also helping to improve clinical outcomes for the patient.

“Our aim was to reduce GP workload to a more manageable and sustainable level to improve staff morale, encourage effective teamwork, and maintain excellent clinical outcomes and continuity of care for patients. We propose to reduce the total number of non-essential GP encounters by 10% and to reduce the number of repeat prescription signings by 20%.

“Firstly we advised patients that same day appointments could only be obtained by telephoning the practice first. Previously we had an ‘on-call’ system which ran for six hours each morning, and was managed by two GPs each day. Patients were able to walk in to the surgery in the morning for an appointment on the same day.

“We recruited a clinical pharmacist to run a morning telephone triage service. This gave the clinical staff the opportunity to triage the patient by telephone first and signpost the patient to the best service to meet their needs. It also ensured that any complex and / or urgent patients were identified quickly and seen by the GP that day.

“We replaced one of the GPs with the clinical pharmacist from Tuesday to Friday; the Monday clinic continued with two GPs with the addition of the clinical pharmacist.

“All repeat prescribing tasks and medication reviews were redirected to the clinical pharmacist. The pharmacist also managed the long term condition reviews and engaged in active signposting.

“A three month review of the project has shown positive results. We have managed to reduce the waiting time for patients to see a GP on the same day and have also reduced the total number of same day face-to-face contacts with a GP. Our data shows that 50% of patients who used the telephone triage system are either managed entirely on the phone without the need for a face-to-face GP appointment, or are signposted to an alternative appropriate service such as a community based health provider. We have saved 34 hours of GP time over the working week by replacing one of the on-call GPs with the clinical pharmacist from Tuesday to Friday and by reducing the running time of the service by two hours each day.

“Staff surveys completed pre and post changes have also proved very encouraging. Our clinical staff report that their workload has become more manageable and our reception staff have noted that there has been a marked decline in the number of patients attending the practice in the morning. This has led to a greater sense of calm in the practice.

“Our pharmacist-led telephone triage system is planned to run over an initial 12 month period, in which time we will measure outcomes at intervals throughout the year to assess the overall value added to the practice.

“Our initial analysis suggests that this is a sustainable means to achieve our objectives in terms of releasing GP time so that they are able to better manage the more complex demands on their time.

“The clinical pharmacist handles all aspects of medicine management, provides guidance on medicine optimisation, and carries out long term condition reviews. We predict this will have a favourable effect in terms of quality outcomes for both the patient and the practice. Although there is a balancing measure in that the project requires an initial, and potentially continuing, financial expenditure, this is offset by the gains made in releasing GP time, cost effective prescribing, and improvements in the overall morale of the practice workforce.”

For more information contact the Islington GP Federation, email inslingtongp@nhs.net