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Call-before-you-walk: Acutely ill patients being diverted from A&E departments, GPs warn


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Exclusive Acutely ill patients requiring emergency care are being diverted to their GP via the new NHS 111 First call-before-you-walk A&E triage system, Pulse has learned.

GPs have reported receiving inappropriate NHS 111 referrals including:

  • an acutely dizzy elderly patient who was later confirmed to have had a posterior circulation stroke; 
  • a patient with acute coronary syndrome; and
  • a patient with acute UTI symptoms.

Meanwhile, GPs are also warning that patients are using the triage system as a way of ‘jumping the queue’ because the route is likely to get them an appointment quicker than calling their practice.

From this month, patients in England are being asked to call 111 before attending A&Es – with 111 triaging them to the most appropriate service, including GP practices.

Scottish patients are also being asked to phone ahead of attending A&E; while pilots are ongoing in Northern Ireland; and Wales is in the process of rolling out a ‘contact first’ model following summer pilots.

The BMA has said the influx of inappropriate referrals by NHS 111 is likely being ‘compounded’ by the new 111 First system, which is ‘contributing to the immense pressures currently facing primary care’.

GPs have raised concerns about several cases in which patients should not have been sent to them by 111 because they required more urgent care.

One GP, who asked not to be named, told Pulse: ‘I had a patient with UTI symptoms – a temperature of 39°C, a heart rate of 140, nausea and abdomen/loin pain. They were told: speak to your GP.’

Patients are also using the system to try and secure appointments more quickly than phoning their GP practice, according to Dr Peter Holden, emergency preparedness lead of the BMA’s GP Committee.

The Derbyshire GP said he has already seen patients who view 111 First ‘as a way of jumping the queue’.

Dr Holden said: ‘A patient calls the practice and is probably offered an appointment for tomorrow. With 111 First, because the algorithms have to be failsafe, 111 will say “you’ve got to see your doctor in N hours” and they’ll drop it into my appointment book, so I then ring the patient.

‘The net result is the patient is seen or heard or speaks to the doctor within an hour or two, so has therefore learned: don’t bother ringing the doctor, ring 111.’

GP leaders, who have previously warned about the introduction of 111 First, said it was vital that call handlers were given appropriate levels of training.

BMA GP Committee chair Dr Richard Vautrey said: ‘NHS 111 is an important triage tool for our busy NHS and has the potential to benefit patients and doctors by directing callers to the right service for them.

‘Recent reports suggest, however, that many GP surgeries are seeing an influx of inappropriate NHS 111 referrals, which are contributing to the immense pressures currently facing primary care – all at a time when we’re still trying to manage Covid-19, preparing to administer the vaccine, and roll out the flu jab.’

He added: ‘This is likely compounded by the introduction of NHS 111 First, which the BMA has raised concerns about, including the possibility of it inadvertently increasing workload for already overstretched healthcare services.’

It comes as NHS England is drawing up plans that could see GPs receiving referrals from A&E departments if patients have not called 111 in advance.

The news of the NHS 111 First model, revealed in July this year, came three years after Pulse exclusively reported that the Government and NHS England were in talks about such plans.

Pulse has approached NHS England for comment.

READERS' COMMENTS [9]

Goldie Nwabue 21 December, 2020 11:41 am

No Suprise here, was always going to end up being that way.
The GP’s let it go ahead ,so inevitably they will have little option but to take it as they see it, of course it was always a means of transferring work from Secondary care to Primary care.
It’s just a Wolf in Sheep’s Clothing.

Decorum Est 21 December, 2020 1:15 pm

Patients are going to die or be severely injured and who will be held responsible? Yes you’ve guessed!
And it’ll not be the Machiavellian funk wits who came up with this plan.

John Glasspool 21 December, 2020 1:35 pm

I would guess that 50% of people attending ED don’t need to be there, and 80% of those attending GPs. (It’s a guess, please don’t ask me for the references.)

Simon Gilbert 21 December, 2020 1:54 pm

‘Doesn’t need to be there’ should only ever be determined by looking at presenting triage symptoms, not by looking at the diagnosis after ct head, bloods and ecg!

Patrufini Duffy 21 December, 2020 2:37 pm

This country loves A+E, like it loves PG Tips and Dairy Milk. You cannot change their addiction – they love telling their mates they had a bit of Casualty, ER or Holby City interaction.

C Ovid 21 December, 2020 2:48 pm

No comment.

Mark Howson 21 December, 2020 5:27 pm

The GMS contract still says it is the GPs decision where and when and if to see a patient. So the. 111 see in 2 hours is not enforceable. The risk is carried by 111 based on how good the triage information is that they pass on and based on that triage info you decide if needs to be seen in two hours or in a week.

Andrew Jackson 23 December, 2020 8:07 am

All though it makes sense for people to be seen by the right clinician in the right place the inability to limit work load is slowly destroying general practice.
Every contract negotiation is meant to help this but there is always a bit of small print such as access to our appointments from 111 that seem to slip through and then open up a huge amount of unresourced work.
We are in year 2 of PCNs and none of our clinical staff have seen any reduction in work intensity, our surgeries are no shorter and nobody goes home earlier and Drs continue to reduce their sessions to survive.
Role on the PCN vote

Victoria Cleak 28 December, 2020 6:59 pm

Has anyone looked up the composition of NHS England’s board? Mostly retail/ finance background. Should be a majority of clinicians but only 2 that I could see.
This must be contributing to why the profession of medicine and the NHS is spiralling downhill.