111 DISPOSITIONS: Requests once a practice has reached safe limit
A common question asked by practices is how to respond to patients directed by 111 to the practice once you have reached a safe limit. When implementing safe working, practices should read the GPC’s Safe Working Guidance: a handbook for general practices in England, and also be aware of their contractual requirement to provide essential services.
Once a practice has reached safe limits it would be inappropriate to just continue to add more patients. The first step should be that on reaching the limit the practice should declare Amber or Red status via OPEL reporting (please note you do not need to answer the question regarding whether you are participating in Collective Action as this is inappropriate).
The view of the LMC is that once a practice has reached a safe limit and OPEL reported to the ICB, their entry on the Directory of Services (DOS) should be changed to amber. Other health services can change their own entry, but general practice must rely on the ICB. Although other ICBs will change the DOS entry on receiving an OPEL report level 3 or 4, LLR ICB refuse to do this at present.
If you receive a 111 request after reaching safe working limits, as always, it is appropriate for the practice to triage the 111 requests again. For patients where the request is for a routine problem, they can be offered an appointment on another day or even placed on a waiting list. Patients can also be triaged as normal and diverted to internal pharmacist, self-access services or Pharmacy First.
If there are any directly bookable 111 slots still available, consider using these.
If the 111 disposition is for a period less than 4 hours this suggests an emergency problem which general practices are not contracted to provide. If the practice concurs then the patient can be diverted to an Urgent Treatment Centre or back to 111 to be directed to a more appropriate service.
There will be times when a practice may need to accommodate an additional appointment or two. If this becomes a regular occurrence, please use the GPC handbook to look how to avoid the situation
THE LMC OFTEN RECEIVES CONCERNS FROM PRACTICES IN RELATION TO 111 DISPOSITIONS - WE ORIGINALLY SHARED THE BELOW COMMUNICATIONS WITH LOCAL PRACTICES
The LMC has receives lots of concerns regarding 111 dispositions to practices. We are aware this is causing general practices a lot of confusion.
The existing NHS Pathways system utilised by NHS 111 providers currently produces general practice disposition with a range of response timescales (1/2/4 hours etc.). NHSEI recognises that practices cannot align their response to these timescales and instead need to manage these patients as on the day activity prioritising as they feel appropriate. (NHSEI, 2021)
When 111 decide that a patient should be dealt with within general practice, it will be a problem that general practice would normally deal with, and practices are not expected to provide the same response as an Urgent Treatment Centre or emergency department, which 111 also book into. This is included in the national Standard Operating Procedure (SOP) designed by national clinical authors and hence something that can only be changed nationally, and not something we can change locally.
This means for example that when a practice gets a 111 response that says it needs to call a patient in an hour, it is acceptable for the practice in how it responds to this and manages it within its existing systems/processes. This also applies to patients booked into the slots available on their systems for 111 to book into directly.
Practices have varied ways in which they deal with patients and this allows practices the liberty to act as they deem fit. As an example, 111 may send an email or task to a practice saying to respond to a patient in an hour, however the regulations advise that practices must consider triaging that patient and decide whether to offer the patient a telephone appointment, appointment with a different health care profession, or at another time or day and inform the patient accordingly.
The LLR ICB team is currently working on a text messaging service with DHU to send to patients to advise them that the practice will contact them as appropriate. This allows a practice to manage a patient as they deem appropriate. This will allow feedback once live and communication will be sent out from the ICB in due course with a frequently asked questions and answers document.Reference:
NHSEI (2021). NHS 111 Booking into General Practice. [online] Future.NHS. Available at: https://future.nhs.uk/connect.ti/P_C_N/view?objectId=858355 [Accessed 3 Feb. 2023].
If there are any questions in relation to 111 dispositions, please feel free to contact the LLR LMC office.