Making Online Consultations Safer for Triage and Follow-Up

Executive Overview

Online consultations help manage demand, but they only work safely when triage, follow-up, and communication are tightly controlled. This guide sets out practical steps for English GP practices to keep digital pathways compliant with NHS England guidance, DCB0160, and CQC expectations.

Map the End-to-End Workflow

Request submission: capture required clinical information, consent, and preferred contact method.
Initial triage: automated checks flag red-flag symptoms; staff review within agreed timeframes.
Clinical decision: allocate to urgent call, routine appointment, self-care, or alternative service.
Follow-up actions: booking, messaging, prescribing, or referral.
Monitoring and closure: confirm the patient received the response and record outcomes in the clinical system.

Visualise the pathway on a single page so all staff—reception, triage nurses, duty GPs—understand how requests flow.

Set Clear Triage Rules and Responsibilities

Time-based categories: urgent (response within two hours), same-day (within the session or by close of business), routine (within two working days), administrative (within five working days).
Escalation triggers: chest pain, severe breathlessness, safeguarding concerns, and mental health crises should default to phone contact and, if needed, 999 guidance.
Named reviewers: rota a trained triage clinician for each session; define cover arrangements for absence.
Secondary checks: include a daily “second look” list for amber cases that might deteriorate.

Document responsibilities in your DCB0160 hazard log and make triage standards part of clinical governance minutes.

Configure the Platform for Safety

Enable automated symptom red flags and ensure they create an immediate alert or task.
Align forms with NICE clinical knowledge summaries so required information is captured consistently.
Set response templates that include expected timeframes, safety-netting, and instructions for urgent care.
Integrate with the Electronic Patient Record (EPR) so triage notes, actions, and follow-up tasks are recorded automatically.

Regularly test configuration after supplier updates and log checks in your safety file.

Communicate Transparently With Patients

Display clear guidance on your website about how online consultations are triaged, response times, and when to use 999/111.
Provide confirmation messages for every submission, including an emergency message and contact number for changes or cancellations.
Use inclusive language and offer alternative routes for patients who struggle online (telephone triage, translation support).

Run Daily Operational Controls

Dashboard review: monitor a live list of open requests, showing age, priority, and assigned clinician.
Twice-daily huddle: quick stand-up to check overdue items, escalate red flags, and share handover notes.
Task ageing rules: investigate any request older than your agreed timeframe; contact patients proactively if delays occur.
Weekend/Bank Holiday cover: decide whether submissions are switched off or rerouted to out-of-hours services; update messages accordingly.

Monitor Quality and Outcomes

Track a focused set of metrics:

Volume of submissions by category and day.
Number of urgent escalations and time to clinician contact.
Count of incidents, near misses, and patient complaints linked to online consultations.
Rate of duplicate contacts (patient calls again because they have not heard back).
Staff workload (triage time per session) to spot burnout risks.

Discuss results monthly in governance meetings and share highlights with the Primary Care Network (PCN) and commissioners.

Support Staff To Use the System Confidently

Provide initial and refresher training covering triage protocols, system use, and escalation routes.
Create quick-reference guides for reception and clinical staff; store them next to the safety log.
Brief locums and temporary staff before their first session, including contact details for help.
Encourage staff to report friction via the safety log so the CSO can update the hazard log.

Engage Patients and Carers

Involve the Patient Participation Group (PPG) when reviewing forms, messaging, and accessibility.
Offer prompts asking patients to confirm that automated advice matched their expectations.
Gather post-consultation feedback quarterly to identify gaps in communication or follow-up.

Scenario: Greenhill Medical Partnership

Greenhill handled rising online demand by:

Publishing a triage charter outlining response times and safety triggers.
Allocating a dedicated triage clinician each session with a back-up rota.
Using a shared dashboard with colour-coded task ageing and twice-daily huddles.
Sending closing messages confirming next steps and reminding patients how to get urgent help. Safety-related complaints dropped, and clinicians reported higher confidence in the digital workflow.

Pitfalls to Avoid

Opening forms when you cannot respond: switch off or reroute submissions during planned closures.
Assuming automation catches everything: always combine automated triage with clinical review.
Forgetting to document decisions: record triage outcomes and advice in the patient record.
Ignoring accessibility: provide options for patients with limited digital literacy or disabilities.

Action Checklist

Map the online consultation workflow and agree triage responsibilities.
Validate platform configuration with your CSO and supplier after each update.
Publish patient-facing information about response times and emergency routes.
Monitor dashboards daily and hold regular huddles to clear backlogs.
Review metrics and patient feedback monthly and update processes accordingly.

Resources to Bookmark

Key Takeaways

Safe online consultations rely on disciplined triage, transparent communications, and continual monitoring. When workflows, people, and technology are aligned, practices can offer digital access without compromising patient safety or team wellbeing.