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


By Costanza Pearce
17 December 2020

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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 on 15 December.

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’.

This story first appeared on our sister publication, Pulse.

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