Total Triage information Email to patients sent 15th Sept 2026
Last Updated: Monday, 28 September 2026
Dear Patients
I’m writing on behalf of the partners and the team at Fulwood Green Medical Centre to inform you of a change to the way we manage appointment requests that will come into effect on Monday 5th October 2026.
What is happening?
On Monday 5th October we are moving to a system known as Total Triage. This means that every request for an appointment will be triaged by a doctor before the appointment is confirmed.
Why is it happening?
NHS General Practice is under more pressure than ever before. We are expected to deliver more services to more patients for less funding year on year. People are living longer and often living with a number of long-term conditions that are managed in general practice. In the past a lot of this care was delivered by hospitals and in most cases the work has passed to practices without any funding to accompany it.
At Fulwood Green we have managed this since 2010 by investing in more GPs, Nurses and other staff to try to meet the rising demand. As our NHS funding continues to shrink, we are unable to afford any more GPs or Nurses to see patients. We currently have the highest GP to Patient Ratio in South Liverpool and have more appointment slots than we have ever had since I arrived at the practice in 2002. Despite this, access for our patients is getting more challenging, not less. Often, there are no routine appointments available and when there are, they are often 6-8 weeks away. At the same time. we have also seen our rate of wasted appointments, where a patient fails to attend for no reason (DNA), almost double since 2023.
Our current appointment system has been in place since COVID-19 and is not working for our patients. It’s also very stressful for our team when we can’t deliver good timely care for our patients.
What is Total Triage?
Total Triage is a system that’s been around for 15 years or so and is increasing in use due to the above pressures. Many of our neighbouring practices already use it.
With appointments being so precious, we need to ensure that each and every one is the right one for your particular need, even if that means it’s not a service delivered here at Fulwood Green.
For every request for care that you make, we will ask you some questions to try to understand what your needs are and get you the correct care for that problem as quickly as possible. This will mean either filling in a simple form online using Blinx PACO via our website or talking to one of our human Care Navigators who can fill in the form on your behalf. Care Navigators are members of our reception team who have undertaken specialist training in supporting patients to access the appropriate care. They can only navigate down pathways as directed by our GPs.
That form will then be reviewed by our duty GP (The Triager) who will decide how best to manage your problem. All triage decisions will be made by a suitable qualified clinician and not a Care Navigator.
This is no different to trying to make an appointment with a bank manager or solicitor. It makes the best use of everyone’s time and gets your problem allocated to the correct resource as quickly as possible
This is not the same as the “call on the day” system that many practices have used in the past and that we know our patients would hate!
The Triager will review your form and communicate the decision to you within half a working day. That decision will allow you to access appropriate care which may be:
A same day face to face appointment
A same day phone call or email
A prescription to help your problem
Some advice about self-care
A “soon” face to face appointment or phone call (2-5 days)
A “routine” face to face appointment or phone call (2-4 weeks)
An appointment at a service in our community
Referral to a community pharmacy
Advice about appropriate care elsewhere.
You will then be able to book your appointment online, at a time that suits you, or ask our Care Navigators to do it for you.
Every request for care submitted before 5:30pm will be triaged on the same day.
Requests after 5:30 pm may be deferred until the following working day and should not be used for urgent issues. All urgent issues after 5:30pm should be phoned through to reception on 0151 727 2440.
Home visit requests, for those patients who are genuinely housebound or receiving palliative care, can be booked by phoning before 11:30am any morning and will be triaged appropriately. Requests received after 11:30am may be deferred until another day.
How will I be informed of the triage decision?
The triage forms or our Care Navigators will ask for your preference of SMS (text) message or e-mail or whether you prefer a phone call. For forms submitted by 12 noon, your will be informed of the outcome by 1:00pm. For forms submitted after 12 noon, you will be informed of the outcome by 6:00pm.
It is the patient’s responsibility to ensure that their chosen communication method is accessible and that you check for messages so you can respond in time, especially if the outcome is a same day face to face appointment. If you miss a call or do not respond in time then you will need to begin the process from the beginning again.
What if I am triaged into an appointment I don’t agree with or can’t get to?
If there is enough detail in the triage form this should never happen. If you feel we have not triaged your problem correctly then you should contact the surgery on the phone. If we have sufficient information though, we are unlikely to change the decision. The appointment booking link we send out as a result of triage will contain a choice of times, days and clinicians so you can ensure you can attend. For urgent problems, we would expect you to be able to attend on the day if requested.
What are the benefits?
We currently spend a lot of time managing same-day demand, some of which does not require input from a GP. This reduces our capacity for routine care and care of patients with more complex health needs. By having control of all our precious appointment slots, we will create appointment capacity whilst assuring there are no wasted appointments.
In most cases when total triage is adopted, DNA rates also fall.
We believe you will find it easier to access us than you currently do.
In local practices, they have also reported improvements in patient satisfaction and staff morale. This is really important to us at Fulwood Green, especially as we prepare for another winter.
What are the risks and what are we doing about them?
|
Risk |
What’s being done about it? |
|
Patients struggle to use the digital forms in Blinx PACO |
Our Care Navigation team are ready to respond to phone calls as they do now and can do all the digital stuff for you. |
|
The expected reduction in appointment slot use doesn’t happen and we end up where we are now |
Our estimate of up to a 30% reduction in the need for appointments is based on national evidence and experience locally but we will have to see what happens and adapt as we go along. |
|
Demand increases with the new system |
We have studied our demand in the last 12 months and planned accordingly. Plan B would involve a “waiting list” for certain appointment types. |
|
What about patients who’s first language isn’t English or have other communication needs |
We have done a lot of work capturing patients’ communication preferences, and these are added to your medical records. Blinx PACO sends all communications in the patient’s first language and includes spoken work, large print and dyslexia friendly support. We have access to telephone translation and sign-language services too. |
How have we made this decision?
The first thing we did was discuss it with our team, listen to their concerns and worries, and create a list of Fulwood Green requirements for any appointment system. We considered various new appointment systems and staying as we are now. It was agreed to explore the total triage model in more detail.
Then we discussed the possibility with our brilliant Patient Participation Group who were challenging and supportive and have helped draft this communication.
The partners then conducted a number of site-visits to local practices who had made this change to learn from their successes and mistakes.
In my other role, I travel the country visiting GP practices and have seen the full range of appointment systems, good and bad. I am convinced that Total Triage gives us the best chance of delivering timely, safe care to our 7000+ patients.
How will we monitor the change?
With the support of our Patient Participation Group, we will monitor demand, appointment slot use, DNAs and patient satisfaction initially after 2-3 months and then annually.
We will make tweaks and changes to the system as we discover teething problems and will report them to our patients.
Are there any appointments that won’t require a triage?
Yes. Patients will be able to book directly into the following appointment types like they do now:
· Long-term condition appointments with the nurse (Diabetes, Blood pressure etc)
· Cervical Smears
· Vaccinations and Immunisations
· Baby Clinics
· Midwife led antenatal sessions
For more information, please visit our website www.fulwoodgreen.co.uk
Click here to watch a video of me trying to explain the situation: {link}
Please also see {here} a helpful user-guide for how the process will work
Some patient information about General Practice from the NHS:
https://www.england.nhs.uk/long-read/you-and-your-general-practice-english/
More information about how General Practice is changing:
https://www.england.nhs.uk/gp/national-general-practice-improvement-programme/modern-general-practice-model/
We’re very lucky at Fulwood Green to have supportive and understanding patients. This was brought home to us during the pandemic and every Christmas when we’re humbled by the kind gifts and good wishes. We wholeheartedly believe that this change will benefit all of our patients and help us to deliver better care. We ask for your patience whilst we roll it out and identify teething problems and your support in following the steps outlined above when you need to request help from us.
Kind regards and thanks as always for your support.
Dr Bowers on behalf of all at Fulwood Green