Nurse-led triage at Homewell: The story so far

July 29, 2022

At Klinik, we want to ease pressure on GPs and make the most of the clinical and non-clinical workforce. Nurse-led triage can help ensure patients get the right care for their needs, and Klinik can play a central role in this approach.

This has been evident at Homewell Practice in Hampshire, where advanced nurse practitioners (ANPs) are helping to ease the workload burden. They are using Klinik’s online triage technology to deal with many enquiries themselves, signpost patients to the right type of care and share the workload across the whole practice team.

Homewell’s approach echoes the nurse-led triage model in use in our native Finland. Here, highly-trained nurses review all incoming enquiries to help ease the pressure on GPs. It’s a proven model; we are not surprised to see that pre-pandemic research found that such an approach could save thousands of GP appointments.

So how does a practice go about making the most of nurse-led triage? Business Manager Alisha Mayaki provides an update on how it is working at Homewell, following on from a webinar we held with the practice in 2020.

How Klinik is supporting nurse-led triage

Homewell Practice is based in Havant, Hampshire. It serves 14,500 patients with six salaried GPs and partners.

Enquiries that come into the practice online are processed in Klinik Access. If they come in face to face or via the phone, frontline staff use Klinik Connect. Both systems capture patient information consistently with intuitive questions and body maps that allow patients to indicate their needs.

Klinik then uses AI to analyse the information and indicates the potential urgency and priority for each case, which helps Homewell’s ANPs to decide on the best course of action for each patient.

“Our ANPs can deal with many of the cases that come in straight away,” says Alisha. “This is useful, as many patients need same day care.”

ANPs can direct patients to other members of a broad multidisciplinary team, both inside and outside the practice. Some may go to the duty team for the GP to review, or ANPs can book home visiting slots using Klinik.

The ANPs can also direct patients to the nursing team, for example if someone needs a dressing or a blood test. ANPs can also signpost patients to the social prescribing team. The leadership team can be notified of any issues, using an inbox monitored by admin staff.

Other cases will be fed through to a dedicated care navigator. They can liaise with other care providers such as the community pharmacy team, or direct patients to out-of-hours provision.

The impact of nurse-led triage

The use of nurse-led triage has had an impact on the makeup of the team and the nature of its work.

“Our model is very different from most,” Alisha says. “We have eight ANPs, whereas many practices would just have two.”

As a result of ANPs picking up the bulk of cases, practice partners are speaking to patients for longer, and so can see fewer patients per day.

“The people that get through to GPs need more attention and fuller investigation,” says Alisha. “This is especially helpful for us, as we work with some very deprived areas. It means we see a lot of patients with long-term conditions or mental health issues, who tend to benefit from more time with their GP.”

The approach also gives the practice more flexibility with how they manage demand. A GP may have 12 phone calls or four face-to-face appointments per session. The GPs can extend the time for each appointment if they wish, or increase capacity by bringing down face-to-face numbers.

Other staff members have found that Klinik helps to take away the brunt of phone calls.

“The phones used to ring off the hook every Monday. Now with online access, most enquiries go straight through to our ANPs,” says Alisha.

Becoming a reliable member of the Homewell team

Klinik’s intuitive design has helped to embed the system within Homewell, and meant that it could be introduced without fear of huge disruption.

“We use Klinik every day,” says Alisha. “It is very user friendly, even for new staff. Very little time is spent training. We can also adapt the system to our needs easily, for example adding extra tiles to the home screen for flu and Covid when required.

“It is one IT system that we have very few issues with. No one has any complaints about Klinik.”

Alongside its reliability, Alisha was full of praise for Klinik’s customer support. “The Klinik team is always very quick to respond to our requests,” adds Alisha. “They are great communicators, and will always listen to our needs.”

Other practices may be thinking of using Klinik to help them introduce new models of triage. What would Alisha tell others in such a position?

“My advice for others would be to start simple, and then expand. Klinik is a great tool but it could get overcomplicated. Build on strong foundations and robust processes, and you will succeed in taking the pressure off your GPs.”

With Klinik in place, Homewell can feel confident that it can provide the right care first time using its nurse-led triage approach. It has the team and the processes in place to make sure that patients get the most appropriate care, and practice staff feel less overwhelmed.

Key stats

Homewell received over 6,000 appointment requests in the first two months of the year. Of those, 900 were 6,179 emergencies - 900 of those, and almost half - 46% - were classed as non-urgent.

"Even our most ardent doubters have seen that demand can be successfully managed with online triage."
Martin Eades, Managing Partner
Priory Medical Group
"We understand our patients like never before. We now have data on the true demand we face in general practice. We have the tools to share that workload across the whole primary care network."
Martin Eades, Managing Partner
Priory Medical Group
"We are seeing 8,000 more patients compared to the same time last year thanks to Klinik, and doing so with the same level of resources."
Martin Eades, Managing Partner
Priory Medical Group
“The system enables our clinicians to review the information provided by patients, and provides a suggested priority level. This allows us to ensure we have the patient see the right person at the right time.”
Dr. Azhar Ali, Managing Partner
Forth Medical Group
"Together with Klinik, we have invested the energy to make it the way we want it to be, and now we are seeing the results.”
Dr Sarmad Zaidi
Roxbourne Medical Centre
“Now Klinik is in place, we don’t ever want to go back. Our reception staff feel less pressured to act according to patient expectations, and the whole team feels that they are better placed to deal with all incoming queries. We can breathe now.”
Trupti Chauhan, Operations Manager
Roxbourne Medical Centre
"Now we know what the demand is, we can see what changes need to be made, and we can manage expectation and optimise the journey for every patient. We can assign the right level of resources to deal with the enquiry, and use the most expensive resource where it’s most effective."
Trupti Chauhan, Operations Manager
Roxbourne Medical Centre
“Feedback from other practices using the system was very positive, especially how responsive the company was to people’s needs.”
Dr Michael Curran, GP partner
Church Street Medical Centre
“For any other practice I would say this would make a valuable addition to the practice. In the current environment, it is becoming essential to have an efficient triage service that can assess risk and identify urgency, so that care can be given according to need, rather than demand. I would strongly recommend this to any GP practice.”
Dr Michael Curran, GP partner
Church Street Medical Centre
"With the Klinik online consultation service, we can now get the correct patient to the correct point of care in the most efficient way."
Dr Thomas Patel-Campbell
Haxby Group