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GPs told not to direct any Covid-19 patients to NHS 111

Patients that call their practice rather than contacting NHS 111 about coronavirus should not be redirected to the national service, NHS England has said.

The GP standard operating procedures have been updated to say that practices must assess any patients that contact them directly, although symptomatic patients are still being directed to NHS 111 ’in the first instance’.

Current NHS guidance for the public states that patients should not contact their GP surgery but should use the NHS 111 online coronavirus service as a first port of call.

However, GPs told Pulse that many patients are ignoring advice and getting in touch with the practice for advice.

Previously, GPs were told to ‘avoid’ sending patients with Covid-19 symptoms back to NHS 111 if they have been unable to get through to NHS 111 or if they have been directed to their practice by a 111 clinician.

But now NHS England has clarified that practices are no longer permitted to redirect any patients to the service and must take responsibility for them, whether they have attempted to contact NHS 111 first or not.

The document said: ’Patients with symptoms of Covid-19 will be directed to NHS 111 in the first instance [but] may make direct contact with practices, or be referred to general practice by NHS 111/the Covid-19 clinical assessment service (CCAS). 

’Avoid redirecting patients to NHS 111 if they present to general practice: this poses significant risk to unwell patients.’

A recent email bulletin sent to practices announcing the upcoming change said: ‘We have received reports that some unwell patients are being redirected to NHS 111 by their GP practice when calling for advice in hours.’

It added that patients contacting their practice should be ‘assessed’ by the practice ’to prevent unwell patients deteriorating due to delays in accessing medical help’.

North Staffs LMC member Dr Andrew Green told Pulse it would constitute a ‘massive change’ for practices and their reception arrangements.

He said: ‘It’s a massive change for practices because if you’ve got your reception team well organised they will direct the patient to 111 if they phone the surgery.’

And Dr Chandra Kanneganti, the BMA GPC’s policy lead on NHS England and North Staffs LMC secretary, added that the new system is ‘unfair’ to practices.

He said: ‘What would really help is for [NHS 111] to triage the call and transfer them to the hot clinic appointment, which they have access to as well.’

However, Surrey GP Dr Dave Triska told Pulse he welcomed the change in policy although ‘lots’ of patients have been calling their practices for advice on coronavirus.

His practice has been dealing with them all throughout the pandemic because they manage them ‘much better’ than NHS 111, he said.

Meanwhile, 111’s Covid clinical assessment service (CCAS) – which may be bypassed by the new arrangements – was a ‘white elephant’ and ‘arrived too late’, he added.

It comes as NHS England has said that it ’still needs clinicians’ to staff the CCAS, which was set up to further triage Covid-19 patients after the NHS 111 algorithm has been unable to determine whether or not they need hospital admission