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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.’