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

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.