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GPs in England receive over 250,000 inappropriate NHS 111 referrals per month



GPs in England receive over a quarter of a million inappropriate referrals from NHS 111 every month, a Pulse survey has shown.

The survey of 616 GPs found that each family doctor received an average of 6.2 inappropriate referrals a month from NHS 111 – which equates to an overall estimated 278,051 unsuitable referrals, based on extrapolation using the total number of GPs in England.

Over 130 respondents said they had experienced more than 10 incorrect NHS 111 referrals a month at their practice, with GPs warning the service is ‘a national disgrace’ and could lead to patient harm. 

The BMA said the safety and efficacy of NHS 111 ‘should rightfully be questioned and scrutinised in depth’. 

But NHS England said the proportion of callers sent to primary care ‘has fallen for each of the last five years’ and that it carries out regular independent reviews of the service.

Since April, changes to the GP contract mean practices are being funded to ensure appointments are available for direct booking by NHS 111.

One GP who took part in Pulse’s survey – and receives more than 10 inappropriate referrals per month – has warned the system could cause patient deaths.

They said: ‘They definitely cause deaths, but no one dares say a thing. Us GPs just talk about it quietly. We are justifiably scared of what will happen if we speak out, I have recent personal experience of this.’

The GP said they had seen women who were bleeding during early pregnancy being given out-of-hours appointments through the NHS 111 direct booking system.

‘I tried to do something about the inappropriate booking of women in early pregnancy who were bleeding but being sent by 111 to GP out-of-hours settings – nowhere near a hospital – as I was clinical lead at the time. But it was impossible, despite several Datix incidences,’ said the GP.

Datix is the incident reporting form used by healthcare professionals to report clinical incidences.

The same GP added: ‘I know it’s still going on, the current contract holders in [my area] are not the slightest bit interested.’

Another survey participant said: ‘A patient with blurred vision was booked in for a 4pm appointment when they should have been sent to eye casualty.’

One GP said they received an inappropriate referral every shift, adding that ‘the most common is patients being sent from an area that is 10 miles away as the crow flies but, due to a large bay, it’s 40 miles minimum by car’.

NHS 111 call handlers are also misleading patients about how urgently they need to see a GP, according to another survey respondent, who also asked to remain anonymous.

They said: ‘NHS 111 is the biggest national disgrace this country has had. Frequently call handlers will inappropriately send ambulances or worry patients needlessly by saying the person needs to contact primary care within one or two hours. It is so sad that call handlers with so little training compared to GPs have so much authority.’

On top of the 616 GPs who responded to Pulse’s survey with the number of monthly inappopriate referrals they receive, almost 200 GPs said they ‘don’t know’ the exact figure.

Oxford GP Dr Chris Kenyon said: ‘Not sure how many…. Putting it another way round, it’s hard to remember appropriate referrals from 111.’

He added: ‘The timescales that 111 set are often unrealistic:- “must” be seen within such & such a time etc.’

Dr Paul Evans, a GP partner in Newcastle, said: ”Cannot quantify, but lots. Bad in normal work, terrible in out of hours – both under and over-triage commonplace.’ 

Dr Farah Jameel, BMA GP Committee executive team’s clinical and prescribing lead, stressed NHS 111 is intended for ‘urgent but not life-threatening health issues’.

She said: ‘NHS 111 acting as a triage tool has the potential to benefit both patients and GPs by directing people to the right service and preventing avoidable GP attendances.

‘Its safety and efficacy should rightfully be questioned and scrutinised in depth.’

She added: ‘It is crucial that patients are given proper clinical triage and call handlers are given appropriate levels of training to ensure that patients reach the right health professional for their condition, and that GP appointments are not wasted. In case of emergencies, NHS 111 must ensure that patients are directed to their nearest A&E.’

The BMA has previously called for the system to be scrutinised, after it had been told about colds and sore thumbs being referred to primary care from NHS 111.

NHS England said NHS Pathways – the triage software used by NHS 111 – is regularly independently reviewed and as all calls are recorded locally, GPs with concerns of individual cases should ‘feed these back to their colleagues so they can be reviewed and acted upon’.

An NHS England spokesperson said: ‘It would be ridiculous and irresponsible to draw national conclusions like this from a tiny, self-selecting survey of 1% of GPs, which takes no account of what people would do if they couldn’t seek advice.

‘Thanks to the increasing involvement of clinicians in triaging 111 calls, the proportion of callers who are recommended to primary and community care has fallen for each of the last five years.

‘NHS Pathways outcomes are regularly reviewed by an independent clinical panel chaired by the RCGP, and all calls are recorded locally, so if GPs or any other clinicians have concerns about individual cases the responsible thing to do is to feed these back to their colleagues so they can be reviewed and acted upon.’

Last year, NHS England tried to ease pressure on GPs by increasing the number of NHS 111 calls that receive clinical input.

NHS England later said that a ‘record number’ of 111 calls were being handled by clinicians.