This site is intended for health professionals only


GPs to receive referrals from A&E under new NHSE proposals


A&E referrals to practices


GP practices could start receiving referrals from A&E departments under a new set of measures proposed by NHS England.

The plans, which are open for consultation until 12 February, said low acuity patients who turn up to A&E without calling 111 first could be ‘streamed’ to general practice.

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

In one pilot area for the ‘111 First’ model, patients were told that if they turned up to A&E without pre-booking an appointment they may not be seen, but rather asked to phone NHS 111 on the spot.

But it remains unclear whether GP referrals from A&E would come via 111 under NHS England’s national plans published yesterday.

The consultation document said: ‘Visiting an Emergency Department before using NHS 111 may mean [patients are] offered alternative services that could see them faster if more appropriate.’

It added that ‘a further £40m’ has been set aside this year to develop ‘processes and IT enablers to appropriately stream low acuity unheralded patients to alternative non-ED settings such as UTCs, general practice, pharmacy and community services’.

The aim is for this to occur ‘to a greater extent and with a more standardised approach than is currently available’, it said.

The report said: ‘Rapid meaningful initial clinical assessment of the needs of all patients, including those who do not arrive by ambulance, is fundamental to our offer to patients, giving assurance that care will be prioritised to those most in need. 

‘This may include streaming to a more appropriate care setting, such as a UTC or primary care facility, and trusts should have systems in place to safely stream patients who do not require ED care to an alternative service supported by robust clinical governance arrangements.’

The document also added that NHS England is exploring how GPs can refer to urgent community response services – which are to be in place 7 days a week ‘over the coming winter’- via 111.

It said: ‘Local clinical assessment services will also simplify the process for GPs, ambulance services, community teams and social care to make referrals, via a single point of access, for an urgent response from community health services.’

The report, which sets out the final recommendations of NHS England’s clinically-led review of NHS standards, said the £40m investment would also go towards expanding capacity in NHS 111.

This will include increasing the number of both call handlers and clinical staff at local clinical assessment services, it added.

It said: ‘Acknowledging that clinical workforce is a clear constraint across all healthcare services, it will be important to do this through driving improvement in productivity through the deployment of new processes and technologies such as video consultation. 

‘In addition, such employment is ideally suited to portfolio careers and for clinicians with their own health problems or caring responsibilities.’

Meanwhile, measuring the ‘percentage of interactions with NHS 111 receiving clinical input’ is one new indicator proposed by the report as part of a suite of metrics to ‘replace’ the current four-hour A&E target.

NHS England said: ‘These models of care are not quick fixes for winter, or in response to the new pressures of Covid-19, but represent the refinement of the vision for transformed urgent and emergency care services. 

‘The NHS has made huge progress over recent years, but there is still more to achieve, and healthcare systems should regard the principles in this strategy as the blueprint for further progress.’

In October, NHS 111’s Covid Clinical Assessment Service (CCAS) restarted GP recruitment amid an ‘ongoing challenge’ to meet demand.

GPs working for the service had previously claimed that NHS England is expanding the scope of the telephone hotline towards a more general clinical assessment service ‘on the sly’.

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.

READERS' COMMENTS [17]

David Evans 16 December, 2020 6:32 pm

Long overdue

Chandni Barrett 16 December, 2020 7:37 pm

Thank you David Evans – Won’t make much difference – my patients that attend AED are seen there and then directed to “make an appointment with your GP” anyway, often having being told, inappropriately, that they need multiple further investigations.

Slobbering Spaniel 16 December, 2020 8:11 pm

‘Go and see your GP as soon as possible who will refer you back to hospital as an emergency ‘

Ferozuddin Sayed 16 December, 2020 8:49 pm

General practice is overwhelmed , so patients go to A&E. There is no quick fix to this problem. We need more AMPs/GPs. At the end of the day is general practice an emergency service or a long term service. Demand always outstrips supply and always will. The more we work the more there is. Patients are not what they were in the 1950s so call as soon as they have symptoms rather than wait 24 hours.

Ferozuddin Sayed 16 December, 2020 8:53 pm

PS where are these appointments in general practice meant to come from?

Y oh Y 16 December, 2020 8:55 pm

Patients need to have access to the right care by the right service (good principle)

Services need to have access to the right funding to manage the patient demand (GP chronically underfunded, staff on brink of collapse, no wave 1 pandemic covid fund so this ain’t coming)

Demand has to be managed by intelligent systems & processes, a cap on how much can be seen for safety and a well educated public. (NHSE oppose a lot of that)

Principles are not enough. There is no goodwill left

James Weems 16 December, 2020 11:36 pm

I wonder if we will be paid by activity if A&E can refer back to us??

Nah…surely not? The never ending sink hole that is general practice, just got that bit deeper.

Hello My name is 17 December, 2020 7:24 am

The ‘vision’ for transformed emergency services is tripe. If you care about patients why not put some GPs in the urgent care areas to offer advice. Oh? Not enough GPs? Just send them away and pretend the problem is solved then. Sort the model. Unlimited access to GP unsustainable. As GPs are overwhelmed we will send more inappropriate stuff to ED because we can’t see everyone. You’ll be back where you started.

Patrufini Duffy 17 December, 2020 12:56 pm

You send one a GPs way, and the profession will send three the other. Or just not pick up the phone. The intuitive will be good at this ping pong.

Rogue 1 17 December, 2020 3:49 pm

Ive already played this game today.
Hospital on-call wont, another not answering their bleep. So all you can safely do is send to AED

John Glasspool 17 December, 2020 3:49 pm

Yes, this is a “referral” so there must be a tariff price for it. Last time I checked, a hospital ED could bill the CCG c £85 once the patient had been checked in; even if they then walked out. Of course, the BMA would never think of doing this for GPs.

terry sullivan 17 December, 2020 4:49 pm

is anyone still a bma member?

A non 17 December, 2020 5:33 pm

as long as all the resources are directed to hospital where work is diligently itemised and costed and kept away from primary care where work is dishonesty amalgamated, uncosted and dumpable, all the bright ideas about how to manage demand will be directed towards reducing demand in hospitals and increasing demand in primary care. its an unstoppable force. Sure as water flows down hill. Its a self fulfilling inevitable process that wont be reformed as long as suckers continue to do the work. An endless treadmill for fools to complain about. Extract what you can from this system as an individual but don’t kid yourself it will ever change. Apart from anything else your ‘ colleagues’ in hospital don’t share your concerns. We’re on our own and as long as the NHS exists, always will be

Paul Attwood 17 December, 2020 5:45 pm

PULSE: 2nd para “low acuity patients?”

Acuity – the ability to hear, see, or think accurately and clearly.

That’ll be getting on for the majority then. (TIC)

terry sullivan 17 December, 2020 6:13 pm

is this about A&E referring your own patients? or any patients?

David Church 18 December, 2020 10:16 pm

OOh, goody!
We can return referrlas if A&E staff have not used the correct form or filled it in correctly, or sent it to the correct fax machine – just as hospitals have been teaching us by rejecting our referrrals for so long!
And of course any rejected referral immediately becomes the responsibility of the A&E doctors to take back and manage, just like when hospital clinics reject GP referrals without telling us.
What a win for General Practice : the hospital will have to take us seriously for once.
I wonder how long it will last?