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GPs expected to 'proactively' monitor Covid-19 patients triaged by NHS 111

GPs will be expected to carry out ‘proactive’ monitoring of some patients with coronavirus symptoms once they have been triaged by a national assessment team, new NHS England guidance has said.

In a letter sent to GPs and commissioners on the weekend, NHS England laid out how patients would be dealt with after contacting NHS 111.

It reiterated NHS 111 online should be ‘the first port of call’ for people with possible Covid-19 symptoms, rather than their GP practice, to ‘free practices to focus on managing those most at risk of complications from Covid-19’.

NHS 111 online will use an algorithm to sort patients into cohorts, including those with severe symptoms who require an ambulance, those with mild symptoms, and those who require further clinical assessment.

GPs will be notified of those high-risk patients who have mild symptoms that have contacted NHS 111, and will similarly be notified of patients with mild symptoms who are advised by NHS 111 to self-isolate at home.

Patients needing further assessment will be passed on to a newly set up Covid clinical assessment service (CCAS) – which will be staffed by a workforce including retired doctors.

Following assessment by the CCAS, if patients do not require hospitalisation or are not showing mild symptoms that can be managed through self-isolation then they will either receive a face-to-face assessment in primary care, or their GP practice will take ‘proactive action’, such as monitoring them by phone.

NHS England said that reliance on NHS 111 online will 'minimise the number of patients contacting their practice for advice unless they have been triaged as requiring it'.

The NHS England letter said: ‘Where CCAS assessment is required, this will result in one of the following outcomes:

' - reclassification as cohort 1 – patient demonstrating severe symptoms, requires treatment in hospital and will likely require an ambulance response’

' - reclassified as cohort 3 – patient is showing mild symptoms and advised to self-isolate at home and to reassess via NHS 111 (online whenever possible) if symptoms deteriorate (GP informed via a post-event message and call closed)

' - requires proactive action from practice – eg telephone monitoring 

' - requires face-to-face assessment in primary care; message sent to appropriate service to arrange.'

NHS England added it only expected ‘a small number of cases’ to require face-to-face assessment by local primary care services.

NHS England's stages of assessment of patients with coronavirus symptoms 

NHS 111 has been commissioned nationally to provide a dedicated Covid-19 response service to free practices to focus on managing those most at risk of complications from Covid-19. A consistent algorithm will be used to stream patients into the following cohorts:

• Cohort 1 – patient demonstrating severe symptoms, requires treatment in hospital and will likely require an ambulance response

• Cohort 2a – symptomatic patients requiring further clinical assessment before final disposition is decided (these are referred to the Covid Clinical Assessment Service or CCAS)

• Cohort 2b – patient exhibiting mild symptoms but has self-declared high atrisk status, having received a letter from the NHS – a post-event message recording this contact will be sent to registered GP for information

• Cohort 3 – patient is showing mild symptoms and advised to self-isolate at home and to reassess via NHS 111 (online whenever possible) if symptoms deteriorate (GP informed via a post event message).

Where CCAS assessment is required, this will result in one of the following outcomes:

• reclassification as cohort 1 – patient demonstrating severe symptoms, requires treatment in hospital and will likely require an ambulance response

• reclassified as cohort 3 – patient is showing mild symptoms and advised to self-isolate at home and to reassess via NHS 111 (online whenever possible) if symptoms deteriorate (GP informed via a post-event message and call closed)

• requires proactive action from practice – eg telephone monitoring

• requires face-to-face assessment in primary care; message sent to appropriate service to arrange.

 Source: NHS England's Preparedness update letter for general practice: 27 March 2020 

Readers' comments (17)

  • Where is the WHO compliant ppe then?

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  • Cobblers

    Anyone tried using NHS 111? It is truly awful. Waiting, waiting, waiting.

    Not any useful kind of service at all.

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  • Why does every algorithm lead to us?

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  • https://www.theguardian.com/society/2020/mar/31/nhs-staff-gagged-over-coronavirus-protective-equipment-shortages?CMP=Share_iOSApp_Other

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  • For about 1week 111 were going to sort all this out.....do not worry..all paths lead back to us as usual..broken boiler...poor housing....inadequate job security...punitive benefits system...global pandemic...poltergeist...who you gonna call..sadly Ghostbusters franchise still not running...yes that will be us then...

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  • 111 is a disaster zone. No discrimination between the sick and the anxious. Hence the back to GP policy.

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  • Pointless. Give us the guidance of who needs to be monitored and what needs a F2F. We can keep an eye on these patients and do daily phone calls if needed. 111 are useless. I have told our patients to contact us first. We have been able to respond very quickly because our patients have really been behaving themselves. I'm actually impressed. Obviously this picture will vary around the country and will depend on the timing of the peak but so far we are coping well and can flex to increase capacity as needed through remote working and home access even with our GPs self isolating they have been working tireless to keep our patients safe

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  • I don’t know why these patients are not just safety netted as we have all patients for years. Proactive calls just creates work for us

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  • David-totally agreed!

    Political?

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  • Maybe, when all this is over, we should give 111 ' proactively' the boot and re-invent a service, which had actual input by clinicians . 111 has bee unfit for service by design.

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