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GPs call for suspension of NHS 111 referrals into overstretched practices

emergency care

GPs in England have called for practices to be able to ‘switch off’ NHS 111 referrals when practices are being overwhelmed with demand.

The England LMCs conference also heard that the service is ‘not fit for purpose’ frequently booking people into GP slots for non-urgent issues.

In all 98% of agreed that the service is causing delays in general practice, ambulances, and A&E departments for problems that can wait, that GP practices must have the ability to turn off direct bookings when they are under pressure.

Dr Paula Newton from Cambridgeshire LMC said she had recently provided advice to the parents of a child with upper respiratory tract infection symptoms including to have a PCR test.

Around 30 minutes later the child appeared on the direct booking list from NHS 111 because the parent had not wanted to do a PCR and demanded to be seen.

She told the conference: ‘Can you imagine a secondary care consultation, which is also likely to be remote, being hijacked in this way.

‘How can this be a safe and effective way to provide care in a health service on it’s knees.’

Dr Carter Singh, speaking for Nottinghamshire LMC, said general practice had become ‘111’s dumping ground’.

‘At one point the workflow to fulfil the requirements in our practice equated to an extra full-time GP,’ he said saying it allowed patients to game the system and allow access to the duty doctor via the backdoor for chronic routine problems.

He said local attempts to try and solve the problem had not worked. ‘We need the clout of our GPC to help negotiate to either withdraw this service or design it to dovetail intuitively with general practice in a way that’s manageable and improves quality and standards.

In bringing the motion to the conference, Derbyshire LMC member Dr Peter Holden said GPs should not be the answer to ‘Amazon Prime’ culture.

‘There is simply not spare capacity in general practice to provide urgent unscheduled immediate response and therefore 111 should not be allowed to dispose cases into general practice other than for routine bookings.

‘111 has become the route by which the sharp elbows push their way to the front of the queue irrespective of clinical need.’

Dr Ben Molyneux, the GPC policy lead on the issue, said he was supportive of all the motions but particularly around being able to switch of direct booking.

GP practices are required to make one appointment per 3,000 registered patients per day available for direct booking by NHS 111.

During the pandemic this was increased to one appointment per 500 registered patients per day but this temporary mandate ended 30 September.

Motion in full

10 AGENDA COMMITTEE TO BE PROPOSED BY DERBYSHIRE: That conference, with respect to NHS 111:

(i)  believes that general practice is not an emergency service and cannot safely receive one / two hour dispositions from NHS 111 services and demands that these stop PASSED

(ii)  recognises that it has become a conduit for patient flow, causing delays to ambulance services, A&E departments and NHS general practice for non-urgent issues PASSED

(iii)  calls for its wholescale review so that protocols, staffing, and funding are fit for purpose PASSED

(iv)  demands that all direct NHS 111 bookings into NHS general practice are suspended where an OPEL4 / Red alert (or equivalent) has been declared by the practice. PASSED

Source: BMA


Andrew Jackson 26 November, 2021 9:46 am

We have had a number of small print contractual changes over the years that get slipped in which then lead to massive implications further down the year. This is just the latest.
As a profession we are either being naïve or not reading our contracts before signing and then predicting what this will mean down the line.
The next one is the PCN responsibility for provision of OOH which may reach us sooner than we think as the OOH situation with A+E, 111 and Ambulance services continues to implode.

Reply moderated
Turn out The Lights 26 November, 2021 10:31 am

Lot of red line being cross time to retire

C P 26 November, 2021 1:23 pm

Getting out of partnership was the best move I’ve made.
The GMS contract has been stripped for PCN DES funding and that is simply unpalatable

David Church 26 November, 2021 4:18 pm

When was a contract last signed by the Practice? They just get imposed?

Anyway, whay are all these 111 patients not being sorted by the ‘advice and guidance’ service before referring for a gP appointment ? They ought to be!

Simon Gilbert 26 November, 2021 5:11 pm

The London 111 dispositions marked as suitable for general practice include accidents/minor injuries (not GMS/PMS and should be directed to urgent care centre contract holders) as well as some maternity problems such as reduced fetal movements.
I’ve highlighted this but apparently it can’t be changed unless all practices are changed so will depend on some central committee’s deliberations at some point.
I recommend GPs ask to see their 111 disposition list.

Esmat Bhimani 29 November, 2021 3:14 pm

I fully agree with Dr. Singh. It is not only general practice that is a dump yard for 111. OOH is even worse. Any and every service that is deficient is passed on to OOH.We get ankle injuries, cardiac chest pain with even raised troponin levels, cases which max-facial have said nothing can be done, carer has not come, the list is endless.

Robert James Andrew Mackenzie Koefman 29 November, 2021 6:20 pm

All practices are under pressure should just be stopped completely