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NHS 111 ‘not sensitive enough’ to pick up potentially fatal conditions

NHS 111 call handlers are unable to identify potentially fatal cases of sepsis because the system is not sensitive enough to pick up red flags, according to a report into the tragic death of a 12-month-old toddler in 2014.

NHS England’s report into the death of William Mead from septicaemia after a long-lasting chest infection found a series of factors were to blame, including pressure on GPs to reduce antibiotic prescribing and A&E admissions, and GP workload pressures.

It concludes that NHS Pathways, the system used by NHS 111 operators, was not sensitive enough to identify sepsis red flags such as a sudden drop in temperature.

Additionally, the report suggests that if a medically trained person had handled the call from William’s mother, they would have recognised his cries of distress in the background as something warranting further medical attention.

GP leaders said that this case proves that inexperienced call handlers should not be triaging calls, and there needs to be greater clinician input.

The helpline was introduced in 2013, using NHS Pathways to guide the non-medically trained call handlers through a series of questions to determine the patient’s condition.

It has been heavy criticised by GPs, with LMC leaders last year calling for it to be scrapped.

Pulse has previously reported that three-quarters of NHS 111 referrals to A&E are unnecessary and three-quarters of NHS 111 referrals to general practice are inappropriate further showing the flaws in the system.

However, the report concludes that there are also risks of missing potentially life-threatening cases.

It said: ‘The NHS Pathways tool used nationally by all NHS111 service providers has limited sensitivity to red flags relating to sepsis. Patients that experience minor symptoms might therefore not be identified when using this triage tool.

‘In particular, subtle changes seen in a deteriorating paediatric patient are not easily identified through the structured questioning within the pathways.’

The report also criticises pressure on GPs to reduce antibiotics prescription or refer to A&E, as William had previously presented at the practice with a chest infection.

It says: ‘it is clear from this investigation and from ongoing conversations with GPs that they are under constant pressure to reduce antibiotic prescribing and referrals to acute hospital A&Es… It is the panel’s view that GPs feel this pressure acutely and it might well have had an impact on their decision-making and practice in this case.’

Former GPC negotiator Dr Peter Holden told Pulse that this was a very sad case ’but of course this is what happens when you try and mechanise a triage system that requires judgement’.

He added: ‘Triage requires the most experienced person to do it successfully therefore it is no surprise that a lay person running a computer program that cannot exercise judgement will fail. We have been saying this for four years.’