A Stratification Tool

An ageing population and an increase in the number of people living with long-term conditions has meant a significant rise in demand for GP appointments. The average person sees a GP six times a year; double the rate a decade ago. The number of GP’s and GP appointments however is not increasing to match this demand leaving the profession feeling stretched and burnt out. 

The incorporation of non GP roles into General Practice is providing a solution but for the greatest efficiency and safety of the service it is important there is a process for signposting patients’ requests for appointments to the most appropriate clinicians. Clinical roles include paramedics, physician associates, Advanced care practitioners and pharmacists.

How it works 

Co-Formation’s Stratification Tool has been designed to enable delivery of care directed by population segmentation and provides a blueprint for tier-based care. 


The tool divides patients into tiers depending on their background medical complexity. This information helps determine the most appropriate clinician to see based on their skill set.


Tier 1 patients have low medical complexity, not having multiple co-morbidities or being physiologically more at risk of illness ( for example the very young or very old) 

Tier 2 patients are the bulk of the remainder of patients, those who are living with long term conditions and often take multiple medications or are physiologically more at risk.

Tier 3 patients are the most complex patients, and identified by clinicians as being at a time in their life where they need more intensive input and continuity of care - for example, care home patients or end of life patients.


The role of the GP will span all 3 tiers but not always needing to be the primary deliverer of care. For instance, in Tier 1 with low complexity patients, the GP role becomes that of the overseer, providing advice and support to the other clinicians for the more challenging problems. 


Advantages of using this tool

  • Allows patients to be directed to the clinician who will best be able to help and manage their medical issues
  • Reduces the need for repeat appointments due to initial clinician not having skills to fully manage a medical problem
  • Helps to maintain continuity of care in patients where it matters the most
  • Allows for longer appointments where likely to be needed
  • Urgent on the day appointments still managed by clinicians who have appropriate skill sets 
  • Supports training and develop of clinicians new to primary care who would start seeing Tier 1 patients and progress to Tier 2 


Data Analysis

The tool can also capture historic data about the delivery and use of appointments across the practice. This can help in service redesign including appointment schedules, staff recruitment and calculating the costs of appointment delivery.


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