This appointment book structure is an example from a ~4,000 patient practice in Cheshire and Merseyside ICS. They went live with total triage at the end of July 2023 and have 2 GPs.
Preparation
They started with an analysis of the appointment bookings from April to July to see what the breakdown was in that period for each GP.
To get a best guess of the mix of appointments needed for each GP on each day of the week, they looked at the time in days from the point of booking to the appointment (on the day, within a week, within 1-2 weeks, 2 or more weeks) for each of the national slot categories (routine, acute, triage, planned etc.).
Triage method
Both of their GPs triage in addition to their morning and afternoon appointment sessions. They triage within Accurx as all requests needing clinical decisions land in the 'Clinical Triage' team’s inbox.
Reception assignment
They assign to reception any requests they want the reception to book appointments for, stating whether they are Red, Amber 1, Amber 2, or Green, whether face-to-face or telephone (see slot type key below...).
They will also assign back to reception anything that can be booked with an ANP via the extended access service or any other practitioner, such as a mental health nurse, first contact physio, or a pharmacist. They also signpost to other services such as primary eye care, community pharmacy referral scheme, minor injuries, and A&E.
Reception also deal with the requests in other ways, such as preparing blood forms and contacting the patient with a Florey.
Clinical assignment
Any triage requests the GPs need to deal with on the day themselves, they will add to their 'triage' session in their EMIS appointment book and deal with them whenever they can.
These triage sessions are set up to be hidden from patient-facing services and the diary, so there is no danger of patients turning up!
Slot type key 🔑
Green – Routine up to 4 weeks.
Amber – Triaged as Amber 1 (appointment within 7 days) or Amber 2 (appointment within 7-14 days).
Red – Now/current session.
Embargoes 🛑
Green – 14 day embargo. If booking more than 2 weeks in advance, the slot is changed to a GP F2F GREEN PLANNED slot when booking.
Amber – Mix of embargoes applied. Same day, 3, 7 or 14 days. Other days of the week there may be 1 day embargoes.
Red – Always on the day and current session.
Monday morning
Structure
GPs will add patients to triage sessions if the request is something requiring clinical input that doesn’t require booking an appointment or signposting elsewhere, e.g. FIT notes and GP letters.
The practice usually receive more requests on a Monday than the rest of the week, so they added this additional triage session in the morning for each GP, just on Mondays.
This was an untimed session but found changing it to a timed session made those not yet actioned more obvious and less likely to be missed, as the pen icon changes to a red exclamation mark.
The slots are set to not DNA and not send reminders. The embargo is set to release on the previous working day. The session is hidden from patient facing services and diary.
A typical Monday morning
A typical Monday afternoon
Same day session – Monday mornings were always walk-in same day clinic before they moved to total triage, so they made the afternoon sessions same day when making the switch to mitigate the same day demand of a Monday 👇
Tuesday morning
This GP usually has more planned reviews on a Tuesday morning, so they put more Green slots on which are changed to GP F2F GREEN PLANNED when booking more than 2 weeks in advance. The Amber slots have a 7 day or same day embargo.
Wednesday morning
The Ambers are a mix of same day, 1 day or 7 day embargoes.
Monday to Friday triage session
The GP will deal with this themselves on the day – hidden from patient facing services and diary.
