Total Triage has moved from being a “good practice” option to being a contractual requirement embedded in the 2025/26 GP contract and the Modern General Practice Access model. From 1 October 2025, practices are required to ensure that every patient request, regardless of channel, is captured, assessed and directed appropriately before an appointment slot is reserved.
This shift responds to persistent problems in general practice: the 8am rush, long waits for routine GP appointments, failure demand when minor issues become urgent, and large volumes of clinical work that never needed a GP in the first place. The Total Triage model explicitly aims to prioritise care based on clinical need, improve equity of access, and remove the mismatch between demand and capacity that drives burnout.
NHS England’s Modern General Practice guidance makes it clear that digital triage, clinician triage and the use of wider teams are seen as key components of the future model, with evidence that such approaches can reduce waiting times, eliminate the 8am bottleneck and improve staff experience. An NHS-funded evaluation of an AI-powered triage system reported a 73% reduction in GP waiting times and smoother demand peaks, demonstrating the scale of change possible when Total Triage is fully embedded with intelligent routing.
From “optimising ARRS” to “Total Triage as demand control”
In the early ARRS years, much effort went into hiring the roles, clarifying supervision and fitting new clinicians into existing practice workflows. That phase is largely over: PCNs across England now have sizeable ARRS workforces in place and are familiar with the headline impacts, such as extra appointments and new services.
The problem you are facing now is different: demand still mostly flows in via the GP list, and only then is it redirected to physios, pharmacists, mental health practitioners or social prescribers. This “GP first” pattern undermines the very point of ARRS and makes it hard to demonstrate that these roles are absorbing GP workload at scale.
Total Triage gives you a new lever. Instead of trying to optimise ARRS in isolation, you can use your Total Triage process as the master switch that decides where work lands across the network. In this framing, ARRS optimisation becomes an output of a well‑designed Total Triage model: if your routing logic is sound, ARRS roles automatically see the work they are funded to do, and GPs are shielded from inappropriate demand.
What Total Triage actually means in the 2025/26 contract
The 2025/26 GP contract changes and Modern General Practice guidance set out a common architecture for access that goes beyond simple online consultation tools. Key elements include:
- All patient requests, irrespective of channel, are received into a single workflow.
- Every request is subject to an assessment of clinical need (urgency, complexity, risk), not just administrative sorting.
- Outcomes from triage can include self-care, community pharmacy, ARRS roles, other services, or GP review—in person or remote.
- Practices must avoid “appointment first” models; triage should come before any appointment allocation.
This is not just an IT change; it is a redesign of your operating model. If you implement Total Triage by simply adding another inbox for reception to check, you will add friction without gaining the benefits. What is needed is a single, structured, data‑rich process that enables consistent clinical decision‑making and role‑based routing.
Total Triage also has a strong equity dimension. The Wandsworth Total Triage programme and Healthwatch reports highlight that practices moving to Total Triage were aiming to improve equity of access by prioritising need, reducing the influence of “who can wait on the phone longest” and making it easier to support vulnerable groups via dedicated pathways. Ensuring inclusivity—through assisted telephone entry, language support and accessible communication is therefore part of getting Total Triage right.
Evidence: what happens when you get Total Triage right
The Wandsworth GP Federation’s learning from 12 practices provides a rich picture of what effective Total Triage looks like in reality. Practices that implemented Total Triage reported:
- Elimination of the 8am appointment scramble, with requests taken throughout the day and prioritised by need.
- Improved equity of access, including better support for people who previously struggled to get through by phone.
- Increased capacity up to 35% in some practices through better use of roles, reduced duplication and fewer inappropriate appointments.
- Better staff morale in reception and clinical teams, as gatekeeping pressures reduced and clinics contained more appropriate cases.
These findings are echoed in independent evaluations of digital and AI-enabled triage systems, which show reductions in waiting times, improved patient satisfaction with access, and more efficient alignment of demand and capacity. NHS England’s own guidance notes that clinician triage and modern online tools can make it easier to manage patient requests and involve wider teams, with higher satisfaction than traditional models when designed inclusively.
Your task as a PCN leader is to take these lessons particularly around demand capture, role use and inclusive design—and embed them into a consistent, network‑wide Total Triage model using a system like Klinik.
The wider team you already have (and why Total Triage is the key to using them)
Most PCNs now have a diverse set of ARRS‑funded and wider roles, including clinical pharmacists, first contact physios, physician associates, nursing associates, paramedics, social prescribers, mental health practitioners and more. National evaluations show that these roles can increase appointment capacity, improve prescribing quality and enhance patient experience when deployed effectively.
However, utilisation varies widely. The NHS Confederation’s assessment of ARRS impact notes that some roles are underused because demand flows do not naturally reach them, and because practices differ in how integrated these staff are into routine workflows. Research from the University of Bristol highlights that the impact of ARRS staff on workload and patient outcomes depends heavily on how they are embedded and what work is routed to them.
Total Triage is the missing link. Instead of waiting for GPs or receptionists to signpost patients to ARRS clinicians, you can design your triage pathways so that:
- MSK‑type presentations flow straight to first contact physios, with clear red flag escalation.
- Medicines and polypharmacy issues are directed to clinical pharmacists as first contact.
- Social, financial or housing-related needs are identified and routed to social prescribers or care coordinators.
- Stable long‑term condition reviews are allocated to nurses, health care assistants or physician associates according to protocols.
Once these routing rules are embedded into Total Triage logic, utilisation of ARRS roles becomes a product of everyday flow, not an afterthought.
Right point of care, first time: the organising principle
The organising principle for a modern Total Triage model is “right point of care, first time.” This means that every request is triaged once, and the outcome is the best‑fit service, mode and clinician for that specific problem.
In practical terms, that implies:
- A single intake process that can gather enough clinically relevant information to make a safe decision.
- Standardised ways of classifying urgency and problem type, so similar cases get similar outcomes.
- Configured pathways that route according to both clinical need and actual workforce capacity across the PCN.
- Feedback loops that pick up mis‑routed work or frequent escalations and feed this into pathway refinement.
Without a digital solution, practices tend to rely on verbal descriptions captured at reception and handwritten duty GP lists, which are hard to scale and prone to variation. This is where Klinik’s structured data capture and decision support add value: they enable consistent implementation of the “right point of care, first time” principle at scale, across channels and across practices.
How Klinik underpins a modern Total Triage model
Structured history for every request
Klinik collects a structured clinical history for each request, whether the patient submits it online or the receptionist completes it with them over the phone or at the front desk. The form gathers symptoms, duration, red flag indicators and relevant background information, providing a richer dataset than a brief reception note.
This structured information is critical for safe, efficient Total Triage because it allows the decision support engine to recognise patterns, flag risk and distinguish between problems that look similar at a headline level but require very different responses. It also makes it easier for clinicians to triage at speed because they see consistent summaries rather than free‑text notes of variable quality.
Decision support and urgency scoring
Klinik’s decision support uses the gathered data to classify urgency, likely condition group and suitable mode of care—for example, same‑day clinician contact, routine appointment, advice and guidance, or self‑care. This does not replace clinician judgement but provides a consistent baseline that reduces variation and speeds up decisions.
Urgency scoring also helps you align capacity with demand. NHS England’s guidance on aligning demand and capacity emphasises the importance of understanding the mix of urgent and routine contacts to design appointment books appropriately, and digital triage systems make that mix visible. When you can see at a glance how many urgent cases are in the queue and how many can safely wait, you can allocate GP and ARRS time much more intelligently.
Bespoke routing rules tuned to your PCN
Crucially, Klinik’s pathways are configurable. During implementation, your PCN defines routing rules that reflect your actual workforce, hub models and risk appetite. Examples include:
- MSK‑related questionnaires routing directly to a PCN physio hub, with automatic GP escalation if red flags are present.
- Medication and side‑effect queries flowing to the clinical pharmacy team, with clear escalation criteria for complex or high‑risk patients.
- Non‑clinical issues—benefits, housing, social isolation—routing to social prescribers or link workers.
- Routine asthma or hypertension reviews going to nursing or associate roles, leaving GPs to focus on undifferentiated or complex cases.
Because these rules sit inside the Total Triage workflow, they apply consistently to all requests, regardless of which practice the patient is registered with or how they contact you. That is how you turn Total Triage into a network‑wide routing engine rather than a set of local workarounds.
Central oversight and safety net
A major concern for PCN leaders is safety: you need confidence that Total Triage will not miss high‑risk presentations or overload particular teams. Klinik supports central oversight so that urgent and complex cases can be flagged to senior clinicians or duty teams, while routine and role‑appropriate work flows directly to ARRS queues.
This aligns with evidence from Wandsworth and elsewhere showing that governance and consistent triage standards are critical success factors for Total Triage. Practices that have clear escalation pathways, strong clinical leadership and regular review of triage decisions report better outcomes and higher staff confidence. Klinik’s configurable rules and audit trail support that governance.
Designing a PCN‑wide operating model around Total Triage
Step 1: Map your real demand
Many PCNs underestimate how much of their current GP workload could safely move to other roles or services. The first step is to quantify your demand by category, drawing on learnings from Wandsworth practices and NHS demand‑capacity guidance.
You can start with a four‑week audit using Klinik or manual coding:
- MSK and injury presentations.
- Medicines and prescription-related queries.
- Long‑term condition reviews and monitoring.
- Acute undifferentiated presentations.
- Mental health, including crisis and sub‑threshold problems.
- Admin and workflow requests (forms, letters, fit notes).
- Social and non-medical needs.
Once you have this broken down, you can overlay your ARRS and wider workforce capacity to identify where Total Triage could immediately route work away from GPs.
Step 2: Define scopes of practice and escalation rules
Next, you translate your workforce mix into clear scopes of practice, informed by national guidance and local experience. The Wandsworth programme highlights the importance of agreeing, in advance, who will triage, what they will handle, and how escalation works to avoid variation and conflict.
For each role or team—GPs, pharmacists, physios, paramedics, mental health practitioners, social prescribers—you should define:
- Presentations they will manage as first contact.
- Situations where they will provide advice and return the patient to the GP if needed.
- Clear red flag or complexity thresholds that trigger escalation.
These definitions then become configuration rules in Klinik, ensuring that Total Triage outcomes reflect real scopes of practice and are not just theoretical.
Step 3: Configure Klinik as your PCN front door
With scopes defined, you implement Klinik as the single digital front door for all practices in your PCN, covering online requests and assisted telephone entry. Every contact now enters the same structured triage process, meaning you can see, in one place, all the requests and how they are being routed.
You configure:
- Shared pathways that apply across the PCN (for example, adult MSK, repeat prescriptions, sick note requests).
- Practice‑specific rules where needed (for example, local clinics or specific services).
- Hub routing to PCN‑wide teams, such as physio or clinical pharmacy hubs.
This architecture mirrors the Modern General Practice model diagrams that show a single intake leading into triage and then into multiple outcome streams, including wider teams and external services.
Step 4: Build a communications and change plan
Total Triage is as much a change project as it is a technical one. Wandsworth’s learning sets out a detailed checklist: project leadership, GP championing, staff training, reception scripts, patient communications, and a clear “go live” strategy.
For a PCN‑wide roll‑out, you should:
- Appoint a PCN Total Triage lead and identify practice‑level champions.
- Use common messaging across practice websites, SMS, posters and social media to explain the new model and reassure patients about equity and safety.
- Provide scripts and FAQs for reception teams, including how to support digitally excluded patients.
- Decide on soft vs hard launch, and whether to cap daily demand or use overwhelm strategies.
Klinik supports this by offering a consistent user experience at the digital front door and by enabling assisted entry so that non‑digital patients still enter the same Total Triage pathway.
Step 5: Measure, learn and iterate
The most successful Total Triage implementations treat go‑live as the start of a continuous improvement cycle, not the end. You can use Klinik’s analytics and ad hoc audits to track:
- Proportion of contacts going to GPs versus ARRS roles and other services.
- GP appointment volumes and waiting times before and after implementation.
- Internal transfer rates (where work is re‑routed after initial allocation).
- Patient feedback and Healthwatch themes on access and fairness.
Wandsworth practices emphasise the importance of “constant tweak and change in response to regular feedback,” including clinical meetings to discuss risk tolerance and triage variation. With Klinik, changes to routing logic can be implemented centrally and tested iteratively across the PCN.
Reducing internal transfers and rework: a core efficiency gain
Internal transfers where a request bounces between clinicians or services are one of the biggest hidden drains on PCN productivity. Examples include:
- A GP appointment that ends with a physio referral for a straightforward MSK complaint.
- A medicines query that starts with a GP but is then passed to a pharmacist.
- A social issue that passes through several clinicians before reaching a social prescriber.
Every transfer generates messages, follow‑up tasks and delays, while eroding patient confidence. Total Triage, implemented with a routing engine like Klinik, can significantly reduce this by sending the work to the right role at the first touch where clinically safe.
The Wandsworth case studies note that increased capacity partly came from reduced duplication and re‑attendance and from better signposting to ARRS roles and community services. Likewise, the AI triage evaluation found that aligning triage outcomes with the right clinician reduced appointment pressure on GPs and smoothed demand. When your Total Triage logic is tuned to your workforce, each request has a high chance of being resolved without unnecessary escalation or transfer.
Impact on GP capacity and sustainability
Protecting GP capacity is now a survival issue for many PCNs and practices. The combination of high demand, constrained GP numbers and increasing complexity means that anything that does not directly require a GP should be handled elsewhere if safe.
Total Triage is your mechanism for enforcing that principle. If every request flows through a system that asks, “Who is the lowest‑cost, safest competent person to manage this?”, then GPs naturally become reserved for high‑risk, undifferentiated or complex cases. The Wandsworth programme explicitly notes that clinics become more complex under Total Triage and recommends adjusting appointment length and volumes accordingly.
The AI Smart Triage evaluation quantified this, reporting a 73% reduction in waiting times and significant improvements in staff working patterns after implementing AI-enabled triage and routing. Although local numbers will vary, PCNs using structured digital Total Triage have reported freeing multiple GP sessions per week per practice by increasing the proportion of work handled by ARRS roles and other services.
For PCN leaders, this capacity release is not just about day‑to‑day breathing space; it underpins your ability to deliver continuity for complex patients, proactive care for long‑term conditions and strategic initiatives with ICBs.
Total Triage and equity: avoiding digital exclusion and unintended harm
A common concern about Total Triage, especially when digitally enabled, is the risk of exacerbating inequalities or excluding patients who cannot or prefer not to use online routes. Healthwatch reports and think tank analyses emphasise that digital triage must be implemented inclusively if it is to enhance, rather than undermine, access.
Key principles include:
- Maintaining telephone and in‑person routes, with reception teams completing Klinik forms on behalf of patients so everyone enters the same Total Triage process.
- Providing clear information in plain English and accessible formats, avoiding jargon and ensuring patients know they will not be disadvantaged if they cannot use online forms.
- Monitoring access and experience for vulnerable groups and making adjustments (for example, dedicated lines, proactive recall, or specific scripts).
NHS England’s Modern General Practice model emphasises that digital routes should “augment not replace” telephone and face‑to‑face access, and that practices must actively consider inequality impacts. Klinik’s assisted entry and consistent workflows support this by ensuring that non‑digital patients are still fully part of your Total Triage system.
Using Total Triage to support a PCN hub model
Many PCNs are moving towards hub models that pool ARRS staff and other resources across practices, to even out workload and create more sustainable roles. Total Triage is a natural feeder into these hubs because it can route requests at PCN level, not just practice level.
With Klinik, you can:
- Route all MSK requests across the PCN to a central physio hub.
- Funnel medicines queries into a PCN‑wide clinical pharmacy team.
- Direct mental health or social needs to specialist teams covering multiple practices.
This enables hub teams to run more predictable clinics, allows better cover for absence, and provides clearer career structures for ARRS clinicians. It also gives you PCN‑level data on demand and performance, which is increasingly important in conversations with ICBs and system partners about funding and service redesign.
Practical examples of Total Triage flows with Klinik
Example 1: MSK back pain
A 42‑year‑old patient reports new lower back pain via the online form, with no red flags, normal mobility and no systemic symptoms. Klinik’s decision support classifies the case as non‑urgent MSK, suggests self‑care advice and/or a physio assessment, and routes the request directly to the PCN physio hub. The physio team provides initial advice and books a follow‑up if needed, escalating to a GP only if concerning features emerge.
Example 2: Polypharmacy concern
An 80‑year‑old patient calls reception worried about dizziness and multiple medicines; the receptionist uses assisted entry to complete the Klinik form. The triage outcome identifies a medicines‑related problem with moderate urgency, and the case is routed to the clinical pharmacy team for medication review, with GP escalation if serious adverse effects are suspected.
Example 3: Mental health and housing stress
A patient describes low mood, anxiety and housing insecurity via the online form. Total Triage recognises a combination of mental health and social needs, prompting a split outcome: initial contact with a mental health practitioner plus a referral to a social prescriber. This avoids a GP appointment that would largely focus on signposting and ensures the patient quickly reaches the practitioners best placed to help.
In each case, the Total Triage process implemented via Klinik ensures that the right clinician sees the case first, internal transfers are minimised, and GP time is reserved for where it adds the most value.
Focused FAQ for PCN leaders
How does Total Triage help us comply with the 2025/26 contract?
The 2025/26 GP contract and Modern General Practice guidance require all requests to be clinically or appropriately assessed before appointments are made, across all access channels. A Total Triage model using Klinik meets this by capturing structured information for every contact, applying decision support, and routing outcomes to GPs, ARRS staff or other services in a consistent, auditable way.
Will Total Triage with Klinik increase GP workload?
When configured correctly, Total Triage shifts work away from GPs instead of adding to it. Routine, low‑risk and role‑appropriate cases go straight to ARRS roles, self‑care or community services, with GPs seeing only escalated or complex cases. Real‑world evaluations of digital and AI‑enabled triage show reductions in waiting times and improved working patterns, not extra GP workload.
How does this improve ARRS utilisation?
Embedding ARRS routing rules into the Total Triage process means work is allocated to pharmacists, physios, PAs, social prescribers and other roles at first contact, rather than after a GP appointment. National analyses show that ARRS roles deliver more value when they are integrated into structured pathways and receive appropriate volumes of work, which Total Triage enables.
What about patients who cannot or do not want to use online forms?
Modern Total Triage models explicitly maintain telephone and in‑person routes, with receptionists using assisted entry to complete the same triage form on behalf of patients. Healthwatch reports stress the importance of clear communication, reassurance about equity and accessible information, all of which can be built into your PCN‑wide communications plan.
Can a single Total Triage model work across multiple practices?
Yes. A centralised digital Total Triage process is designed to sit at PCN level, routing work either to PCN‑wide hubs or to practice‑specific clinicians depending on configuration. This supports shared ARRS staffing, smoother workload distribution and coherent access standards across the network, aligning with NHS England’s modern general practice model.
How do we know if our Total Triage model is working?
You can monitor success using metrics such as the proportion of contacts handled by ARRS roles, GP appointment volumes and waiting times, internal transfer rates, phone traffic and patient feedback. A practice cohort in Wandsworth reported up to 35% capacity release and elimination of the 8am rush after implementing Total Triage, illustrating the type of impact you can look for.