Why Primary Care is NOT a "Triage Service"
The pressure on primary care is due to RAMP up
“You’re just generalists”
“You’re not the specialists..”
“You’re job is just a triage role”
If you haven’t heard some of those phrases concerning primary care you will definitely hear them eventually. Unfortunately, frontline care as a whole has been compared to a “triage service” where primary care clinicians are meant to simply “signpost” patients to the correct specialty.
Unfortunately with the development of strict protocols and stringent referral criteria I can’t blame a specialist colleague of mine having such an impression. The only difference now is that I think that primary care will soon be seen in a different line.
This opinion poll on the Guardian got me thinking. Currently there are 760,000 patients waiting for an outpatient gynaecology appointment around the country. That is a staggering figure as in the same breath, there are thousands of patients waiting for appointments with other specialties around the UK.
This leaves patients frustrated, primary care clinicians at their limit and secretaries sick and tired of letters that write like this:
“Hi xxx. We sent a referral for this patient 3 months ago but they haven’t heard back. Could you write an expedite letter to them.”
What Next?
The problem is that it’s taking a lot longer to see a specialist and this was made worse by COVID. During this time patients remain in pain, continue to have a bothersome rash, have heavy PV bleeding or continue to suffer from back pain.
This keeps them off work and reduces their ability to keep active and healthy. This means that they are risk of developing worse diseases which makes things all the more complicated. This is where we as primary care/A&E/acute medical practitioners come in..
Advice & guidance has certainly made things easier. We are able to get a response to queries which do not always need to end up as a referral. However, all of this puts more pressure on us to provide relevant treatment to a patient.
For instance, I’m certainly not the greatest with certain specialties, but I have decided to read around and upskill purely because I do not want the patient to suffer whilst waiting for a referral. There is SO much we can do to learn more about diseases and start to initiate the treatment. For example:
Developing a basic understanding of pain pathways allows you to choose +/- titrate the correct medication whilst the patient waits for the pain clinic.
Initiating investigations early to save the patient time when they see the clinicians. This might include bloods, ECG and other tests for unwell patient.
Being competent with certain examinations e.g. PV or with procedures such as steroid injections can help the patient better manage these conditions earlier.
Attending CPD courses for subject matters/presentations you encounter regularly.
I think we’re moving away from being seen as a “triage service.” With core investigations such as ultrasound scans being bought into the community setting proves that there is a great need for diagnosticians. You don’t need to be a GPwSI or a clinician with special interest to extend your knowledge in this way but to upskill yourself so you can manage common conditions is vital.
You can see some of our own CPD accredited courses here
Until next time
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