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GPs buried under trusts' workload dump

GPs in England receive over 250,000 inappropriate NHS 111 referrals per month

GPs in England receive over a quarter of a million inappropriate referrals from NHS 111 every month, a Pulse survey has shown.

The survey of 616 GPs found that each family doctor received an average of 6.2 inappropriate referrals a month from NHS 111 - which equates to an overall estimated 278,051 unsuitable referrals, based on extrapolation using the total number of GPs in England.

Over 130 respondents said they had experienced more than 10 incorrect NHS 111 referrals a month at their practice, with GPs warning the service is 'a national disgrace' and could lead to patient harm. 

The BMA said the safety and efficacy of NHS 111 'should rightfully be questioned and scrutinised in depth'. 

But NHS England said the proportion of callers sent to primary care 'has fallen for each of the last five years' and that it carries out regular independent reviews of the service.

Since April, changes to the GP contract mean practices are being funded to ensure appointments are available for direct booking by NHS 111.

One GP who took part in Pulse's survey - and receives more than 10 inappropriate referrals per month - has warned the system could cause patient deaths.

They said: ‘They definitely cause deaths, but no one dares say a thing. Us GPs just talk about it quietly. We are justifiably scared of what will happen if we speak out, I have recent personal experience of this.’

The GP said they had seen women who were bleeding during early pregnancy being given out-of-hours appointments through the NHS 111 direct booking system.

'I tried to do something about the inappropriate booking of women in early pregnancy who were bleeding but being sent by 111 to GP out-of-hours settings - nowhere near a hospital - as I was clinical lead at the time. But it was impossible, despite several Datix incidences,' said the GP.

Datix is the incident reporting form used by healthcare professionals to report clinical incidences.

The same GP added: 'I know it's still going on, the current contract holders in [my area] are not the slightest bit interested.'

Another survey participant said: 'A patient with blurred vision was booked in for a 4pm appointment when they should have been sent to eye casualty.'

One GP said they received an inappropriate referral every shift, adding that 'the most common is patients being sent from an area that is 10 miles away as the crow flies but, due to a large bay, it's 40 miles minimum by car'.

NHS 111 call handlers are also misleading patients about how urgently they need to see a GP, according to another survey respondent, who also asked to remain anonymous.

They said: 'NHS 111 is the biggest national disgrace this country has had. Frequently call handlers will inappropriately send ambulances or worry patients needlessly by saying the person needs to contact primary care within one or two hours. It is so sad that call handlers with so little training compared to GPs have so much authority.'

On top of the 616 GPs who responded to Pulse's survey with the number of monthly inappopriate referrals they receive, almost 200 GPs said they 'don't know' the exact figure.

Oxford GP Dr Chris Kenyon said: 'Not sure how many.... Putting it another way round, it's hard to remember appropriate referrals from 111.'

He added: 'The timescales that 111 set are often unrealistic:- “must” be seen within such & such a time etc.'

Dr Paul Evans, a GP partner in Newcastle, said: ''Cannot quantify, but lots. Bad in normal work, terrible in out of hours - both under and over-triage commonplace.' 

Dr Farah Jameel, BMA GP Committee executive team's clinical and prescribing lead, stressed NHS 111 is intended for 'urgent but not life-threatening health issues'.

She said: ‘NHS 111 acting as a triage tool has the potential to benefit both patients and GPs by directing people to the right service and preventing avoidable GP attendances.

'Its safety and efficacy should rightfully be questioned and scrutinised in depth.'

She added: ‘It is crucial that patients are given proper clinical triage and call handlers are given appropriate levels of training to ensure that patients reach the right health professional for their condition, and that GP appointments are not wasted. In case of emergencies, NHS 111 must ensure that patients are directed to their nearest A&E.’

The BMA has previously called for the system to be scrutinised, after it had been told about colds and sore thumbs being referred to primary care from NHS 111.

NHS England said NHS Pathways - the triage software used by NHS 111 - is regularly independently reviewed and as all calls are recorded locally, GPs with concerns of individual cases should 'feed these back to their colleagues so they can be reviewed and acted upon'.

An NHS England spokesperson said: 'It would be ridiculous and irresponsible to draw national conclusions like this from a tiny, self-selecting survey of 1% of GPs, which takes no account of what people would do if they couldn’t seek advice.

'Thanks to the increasing involvement of clinicians in triaging 111 calls, the proportion of callers who are recommended to primary and community care has fallen for each of the last five years.

'NHS Pathways outcomes are regularly reviewed by an independent clinical panel chaired by the RCGP, and all calls are recorded locally, so if GPs or any other clinicians have concerns about individual cases the responsible thing to do is to feed these back to their colleagues so they can be reviewed and acted upon.'

Last year, NHS England tried to ease pressure on GPs by increasing the number of NHS 111 calls that receive clinical input.

NHS England later said that a 'record number' of 111 calls were being handled by clinicians.

 

Readers' comments (17)

  • Dear Pulse,
    I did a survey in my practice. i just looked at dispositions, i make no comment about appropriateness. Over 100 sequential reports analysed.
    35% of all contacts resulted in a blue light ambulance or a doctor or paramedic dispatched within 1 hour.
    55% advised to see a clinician within 6 hrs
    10% advised self care.

    A complete disaster.

    luckily(?) most of our patients realise they are being given rubbish advice so don't panic but invariably see us to get a sensible opinion.
    Regards
    PauL C

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  • Government policy has been to replace properly trained GPs with a cadre of individuals with inappropriate and inadequate training including NHS111, Paramedics, Nurse practitioners and pharmacists ( heaven help us!). This is done as they are perceived to be less expensive. Given the fact that they make so many mistakes and delay patients seeing someone who knows what they are doing, this state of affairs was entirely predictable. If our leaders, especially RCGP keep making politically correct noises instead of this idiocy the current rate in decline in medical care will accelerate.

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  • What can I say? You get what you pay for. Instead of addressing the issue of doctors pay and condition, the government is trying to use cheap labour to deliver a service that is supposed to be 1st class. Well, you get what you pay for.Remember QoF when it 1st came out to hit all us lazy GPs? They told GPs you have "over achieved". They do not want best care as it costs.

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  • The algorithms may need significant enhancements.

    But without a cheap AI way of managing 65% of demand into self care options, the system is going to collapse.

    Other system clinicians should be supported to pick up another 20% of the demand.

    The final 15% can be seen by our dwindling GP workforce.

    We all need to innovate our parts of the system so this can work, for all of our sakes....

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  • One of the biggest problems is that nurses and doctors, whether in primary or secondary care frequently disagree on who or what is the appropriate service / person to manage a problem (one also has to look at what clinicians are contracted / paid to do). Then take a look at what the Royal Colleges think. Then look at what NHSE / DoH / Government think. Then take a look at what patients think... OMG!

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  • NHS 24 is just as appalling in Scotland. i work OOH and every shift i work NHS 24 makes it 10 times harder than it needs to be. Completely inappropriate referrals, both under and over triaged. Sore thumb for a month- see GP within 4 hours that night, boil on scrotum- OOH within 1 hour. 8 year old insulin dependant diabetic with clear features of DKA- triaged by a nurse at NHS 24- "oh just toddle along to OOH whenever you're ready"!!. Calf swelling after 20 hour flight- coughing up blood, breathless and chest pain- again- just take your time and off you toodle to OOH in your own time!!! They are useless, dangerous and a complete waste of money- they are worse than useless- downright dangerous!! Not a single OOH GP where I work across the board has ANY positive thing to say about them. Repeatedly datix and feedback disasters- never get any word back.

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  • Agree with losthewilltolive - I have loads of examples...tried to call to the triage/ call handlers to discuss- and they weren't interested in any feedback- when it would have been most useful... at the time.... some even refused to give their names....
    one example 26 yr old girl- third trimester- woken from sleep with worst headache ever in a remote area- no access to car so NHS 24 request 4 hr house visit...when sub arachnoid needs urgently excluded... then when I called the patient they felt I was lazy as I was suggesting evacuation rather than a home visit... WTF am I supposed to do on a home visit? The history alone tells you you need a scan... NHS 24 is dangerous, they dont listen to feedback and my experience of their clinical directors is less than satisfactory... excuses and repeatedly being told'm only one person' when all my colleagues feel the same way

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  • Or what about the 70 yr old diabetic with BMs 30, feeling unwell and faint.... living literally a 100 yards away from hospital.... oh no...NHS 24 categorise for a home visit..... when Im 2 hrs away on another call.... needless to say patient collapsed before I got there.... again I called and advised patient to attend hospital.... but thanks to NHS 24 again... patients families are left with impression we are being lazy..... NHS 24 is a liability

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  • Vinci Ho

    (1) Remember whose idea and for what purpose was NHS111 created? Right in the middle of the austerity period .
    (2) The medico-legal implications created pressure on NHS 111 that they must refer to some clinicians with indemnity cover , no matter what to cover their own arses .
    (3) Too expensive to go to A/E(and the appalling headlines of inundated A/E otherwise), so GP land is the perfect dumping ground .

    The injustice created by this monster is simply deplorable, callous and unscrupulous.

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  • My experience echoes these and many others'.

    111 is crap and dangerous. But NHSE and Babylon don't care.

    "NHS England said NHS Pathways - the triage software used by NHS 111 - is regularly independently reviewed" - NOT ACCORDING TO CORONERS' REPORTS.

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