Does total triage and remote-by-default consulting impact vulnerable groups: A pilot study

BackgroundCOVID-19 mandated a rapid and dramatic transformation of general practice. Total Triage (TT), where all consultations should be triaged first, and Remote-by-Default (RbD) consulting, where a clinician should consult remotely unless there is a "clinical exception", were advised. It is unclear how these new ways of working were implemented in practice, and how they impacted vulnerable patients. AimTo assess the impact of TT and RbD on vulnerable patients and identify mitigation strategies. Design and SettingA mixed methods service evaluation in Lewisham, London, an area of high deprivation. MethodThree parallel datasets were collected and analysed: Semi-structured interviews with stakeholders working with vulnerable groups and qualitative data from forums with black and ethnic minority patients, a survey of General Practitioners exploring implementation of TT and RbD, and a mystery shopper exercise reviewing access and messaging of ten practices. ResultsBarriers to access for vulnerable patients included challenges navigating the new model, difficulty engaging with remote consultations and digital exclusion. There was wide variation in messaging regarding changes to services and the practical application of TT and RbD. Potential solutions included clearer practice guidance and patient messaging, more consistent implementation, and identification and recording of patient access needs to enable better tailoring of care provision. ConclusionThis pilot study identified perceived and actual barriers to accessing general practice for vulnerable patients following the rapid introduction of TT and RbD consulting. It proposes immediate steps to mitigate some of these impacts and highlights the need for further research in this area. How This Fits InThe rapid and widespread adoption, recommended by NHS England, of total triage and remote-by-default consulting in general practice has yet to be evaluated. We provide a first look at how these changes are impacting those with historic difficulties in accessing primary care under the traditional GP model. We also provide some local recommendations that can be implemented easily at practice level and beyond, to mitigate the impact of these changes whilst making recommendations for further research to corroborate these findings widely.