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Impact of total triage and remote-by-default consulting on vulnerable groups: A pilot study

Rationale, Aims & Objectives COVID-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. We provide a first look at how these changes are
impacting those with historic difficulties in accessing primary care
under the traditional GP model. This service evaluation aimed to assess
the impact of TT and RbD on vulnerable patients and identify mitigation
strategies using a mixed methods service evaluation in Lewisham, London,
an area of high deprivation. Method Three 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. Results Barriers 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. Conclusion
We identified perceived and actual barriers to accessing general
practice for vulnerable patients following the rapid introduction of TT
and RbD consulting in Lewisham. We recommend immediate steps that can be
implemented at a local level to mitigate some of these impacts, and
propose further work to gain better insights into the issues identified.