111 Referral Standard: Clinical Safety Case Report

This Clinical Safety Case Report documents the scope, functionality and clinical risk management activities for a new standard for 111 Referrals and the GP Post Event Message for Information. It is intended to support vendors and developers as well as healthcare organisations implementing the standard in clinical IT systems.

The Standard v0.4 [Ref 3] has been co-produced with a wide range of stakeholders; NHS E&I Transformation directorate, Royal College of General practitioners, Urgent and Emergency Care Clinicians, citizens, healthcare professionals, and suppliers to ensure that the standard meets their needs.

The following approach was taken to develop the project deliverables

• 2 multidisciplinary consultation workshops and 2 GP Focus Groups (Feb 2022) were held with key stakeholders, including front line health and care professionals, health informaticians. The first workshops in 2018 discussed and reviewed the integrated urgent care information sharing requirements. A further workshop in March 2021 validated the findings of the initial workshop to gather agreement for the continuation of the draft 111 standard. The GP focus groups focused on the GP Post Event Message (PEM).

• Close working with the NHS E&I Booking and Referrals (BaRs) programme to support the 111 to ED pilot for the 111 standard. PRSB attended the BaRs programme board to ensure any hazards were identified and mitigated during the development of the standard.

• A wider consultation on the 111 standard was carried out via an online survey during Nov – Dec 2021. The survey was aimed at frontline care professionals, who either receive or send 111 referrals, people, who work in the 111 services and those who are users of the 111 service. The findings and outcomes of the survey can be found in Appendix 5.

• Outstanding issues were consulted on by the 111 standard project group and the BaRS Programme Board. The outputs from these meetings informed the final drafts of the 111 standard.

• Final drafts of the standard and supporting documentation were disseminated to the 111 project board of their official sign off in March 2022

In scope

1. The scope of the 111 standard applies to:
   • All 111 and 999 service referrals to wherever the person goes next.
   • The GP Post Event Message
   • Referrals through 111 online, call handler or clinical assessment services and 999 services, and is not specific to any triage system.
   • To support NHS Digital with the pilot use case 111 to ED
   • The standard is UK-wide and developed in consultation with a wide range of professionals from all four nations, including from 111 services, receiving services, IT suppliers and people who use services.
   • All age groups including children.

To support the full information journey from 111 receiving the call or online request to referral to an onward service and / or the post event message back to the GP, the standard has been split into 2 sections.

i. The 111 Referral

Below are the high-level data items for the ‘111 Referral information standard’

• Patient Demographics
• GP Practice detail
• Dental practice detail
• Consent
• Safeguarding
• Individual Requirements (Reasonable Adjustments)
• Referral Details
• Caller details
• Presenting Complaints and issues
• Problem List
• Clinical Summary
• Social Context
• Risk
• Allergies and Adverse reactions
• Medications and medical devices
• Plan and requested actions
• Person and carer concerns expectations & wishes

For a system supplier view and human readable view of a 111 Referral to ED see Appendix 7 and navigate to the Examples section of the PRSB 111 standards webpage.

ii. The Post Event Message (back to registered GP)

Below are the high-level data items for the ‘111 PEM information standard’

• Patient Demographics
• GP Practice detail
• Safeguarding
• Individual Requirements (Reasonable Adjustments)
• Referral Details
• Presenting Complaints and issues
• Problem List
• Clinical Summary
• Risk
• Allergies and Adverse reactions
• Medications and medical devices
• Plan and requested actions

For system supplier view and human readable view of the 111 ED PEM example see Appendix 7 and navigate to the Examples section of the PRSB 111 standards webpage.

Out of scope

The standard does not apply to transfers between 111 services (e.g. across a country border) or between 111 and 999 services and these are therefore out of scope. As is the actual implementation of the 111 standard in to organisations and IT systems.