Choreographing Triage: Making Patient Requests 'Flow' Through Digitally Enabled Systems of Access and Decision-Making in NHS Primary Care.

This paper explores the altered landscape of primary care following the accelerated process of implementing digitally enabled triage across UK general practice in response to COVID-19. Traditional understandings of triage are based on a static 'pile sorting' logic, which suggests that triage outcomes depend upon a single decision in time and space. With the introduction of remote, asynchronous and distributed decision-making, triage needs a more dynamic conceptualisation. Drawing on a team ethnography in three GP practices in England, we develop the concept of triage choreography to explore the (often hidden) work involved in achieving the flow of patient requests through triage systems. We ask who participates in this work, who might be excluded and the consequences for triage outcomes. Our findings extend the literature on digital in/exclusion in primary care, providing a critical analysis of 'flow' in digitally enabled triage and what it means for patients. We show how, as patient requests enter digital systems, triaging work becomes distributed, often in uneven ways. And although digitally enabled routes through systems afford faster and smoother movement, they can also limit patients' ability to influence how they access care and the modality in which it is delivered.