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The waiting game

GPs told to avoid 'looping' Covid-19-symptomatic patients back to NHS 111

GPs should ‘avoid’ sending patients with Covid-19 symptoms back to NHS 111 if they have been unable to get through to NHS 111 in the first place, NHS England has said.

In operational guidance for GPs released yesterday, NHS England also said GPs should avoid redirecting symptomatic patients back to NHS 111 in cases where an NHS 111 clinician has told the patient to speak with their GP.

In both of these cases, GPs should assess patients themselves, according to the guidance.

The approach is necessary due to the possibility of symptomatic patients ‘becoming stuck in a loop’ between NHS 111 and general practice, which ‘poses significant risk to unwell patients’, said NHS England.

The guidance said: ‘If patients with symptoms of Covid-19 contact their GP practice, either because they are unable to speak to an NHS 111 clinician or because they have been advised to do so by NHS 111, they should be assessed rather than directed to NHS 111.’

NHS England has said from the outset of the pandemic that patients with possible Covid-19 symptoms are expected to contact NHS 111 in the first instance, rather than approaching their GP.

In cases where patients are able to get through to NHS 111 online – or via telephone - an algorithm will be used 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.

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 GPs and GPs giving up their spare time.

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.

In the NHS England guidance published yesterday, it reiterated that NHS 111’s clinical assessment team may require GP input for patients they have triaged.

It added: ‘NHS 111 clinicians may need to speak to the patient’s GP practice or the local out-of-hours service directly during or after assessment.

'Some patients will need input from their general practice team following clinical assessment through NHS 111.’


Readers' comments (28)

  • David Banner

    We were TOLD to direct these patients to 111.
    111 now directs them back to GP.
    Just who is doing the looping here?

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  • Why is this so difficult NHSE? Are you short of breath or getting worse? If yes - go to hospital. Not go to a hot hub tomorrow, not wait for me to dress in an apron and visit you tonight (for me to perversely keep you at home), not call 111 again, not wait till I call you tomorrow to proactively monitor you. You need oxygen - period and a monitor in a dedicated 'hot place' with plenty of personnel and cleaners called a HOSPITAL. I will like this to be a csa case - red flags positive, keep at home. Unbelievable.

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  • Gluteus Maximus, please meet Olecranon.
    Olecranon, let me introduce you to to Gluteus maximus.

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  • Kevlaecardie, you write so beautifully.

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  • NO! the default position is to dump stuff back in our lap. the monkey is then on your back, and it becomes your problem !!
    they set up 111 to deal with this - there is no point in having 111 at all if they can then "loop" the patient back to us (after keeping the waiting several hours) because they are a bit busier than they would like to be !

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  • The problem with 111 is the usual protocol-driven drivel. I had a patient the other day got "looped back" to GP because she has been having a cough. 111 said you CAN'T have COVID because your cough is not continuous and you don't feel hot and sweaty. She was feeling lethargic, sore throat and loss of smell. Right..... what should I do, if anyone has the direct line for Prof Whitty, where can I at least at a test for this patient because this is not a 111 problem.

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  • Funny when others like 111 are not doing their job they expect GPs (that they have P*ssed off) to clean the mess. Is 111 well led, safe and all that CQC stuff?

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  • all roads lead to early retirement, after this is all over, me thinks.

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  • I am hearing that CCAS won't have access to patient records -despite all our efforts with data sharing with 111 service. Thats isn't going to help the looping.

    If 111 needs us to assess patients -please send your records stating why, and what is being asked of us. Telling patients that they were "told to phone their GP" is not really safe.

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  • It's all very good lambasting 111. But the truth is, they do not have the capacity to review patients. They never have done in hours, and how would they suddenly now, they dont have the manpower or clinical assessment units - they are a telephone service. OOH they can access treatment centres to book patients into, but in hours they refer back to patients own gp. This is normal. Hiw do we suddenly expect them to have magiced up another service to see them face to face? Where have these mythical doctors and nurses come from? They dont exist. It is all very good saying send anyone breathless to hospital, do you have any idea how many people this is ...all the worried well included. With the hospitals and ED departments overflowing this is not a time to be sending everyone in. Our job is to sort the wheat from the chaff, it was ever thus. For the clearly unwell, this is easy - refer direct from a phone call by all means. And yes, 111 can do this For the clearly well, safety net over the phone. Again 111 can do this. But there is a middle group, and a well documented cohort of silent hypoxics who will need checking...sats/heart rate would do. 111 just do not have the ability to do this over the phone! So this falls to us as gps. Its really not that complicated and to be honest I'm bitterly disappointed with some of my colleagues attitude of just ' send everyone to hospital ' 'leave it to 111'. This is a time when we are needed most, not least. The nurses and doctors in hospital, apart from ITU, have the same PPE as us. We need to step up to the proverbial plate and do what is right for our patients

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