111 Referral Standard: Final Report

The following recommendations are made to support implementation, adoption and achieving the full benefits of the engagement and the standard:

1. 111 services should work towards using SNOMED CT for coding the outputs. SNOMED CT is the NHS’s chosen standard for clinical terminology, and there are many advantages to using coded data at both the sending and receiving ends of the referral. The use of SNOMED CT is increasing across the NHS, is specified and used in the developing UK Core FHIR specifications and standards, for other transfers of care standards and used extensively in emergency departments and urgent care driven in part by the use of the emergency care dataset (ECDS) which uses SNOMED CT.
2. Consider if 111 call handlers in England are able to provide a summary for onward referrals as happens with NHS24 in Scotland.
3. Implementation of the general practice PEM should be combined with the implementing the 111 referral to general practices. Consider the workflow and handling in the general practice system to ensure the PEM is distinguished from the referral and both are handled in appropriate ways.
4. Consideration should be given to format and layout of the PEM to ensure it meets the requirements of 111 services and general practice services.
5. The current 111 report or ITK message could be edited to remove the negative responses to the pathways clinical triage, and instead clearly show the resulting disposition (symptom group and symptom discriminator) codes and urgency (DX codes). This would make the current 111 report useful and useable to both receivers of 111 referrals and to general practices receiving the “For Information” 111 report (or PEM).
6. In parallel with the recommendation 5 above, engagement with both general practice system suppliers and general practices could explain the difference between the current 111 report “For Action” (or 111 referral) from the 111 report “For Information” (or PEM) so they can be easily distinguished and handled in the appropriate ways. This could change the use of these current messages to be useful and effective, rather than difficult or ignored.
7. Revise the general practice PEM ‘never send list’ based on feedback from our GP consultation and further engagement with GPs. There are a number of never send conditions where the feedback indicated that GPs would like to receive the PEM.
8. Consider the existing service data sets; ECDS, Ambulance, Integrated Urgent Care when 111 moves to using SNOMED CT, to ensure the codes selected at 111 call handler and/or CAS level will be received and align with these already defined data sets.
9. Pilot and test the BaRS including the 111 referral standard in the other destination areas beyond 111 to ED, as is being planned in the BaRS programme.
10. Primary care systems should be able to handle qualifiers (e.g. a suspected diagnosis) so these functions in SNOMED CT can be used safely all across health and care. This is recognised as being beyond the 111 Referral standard and BaRS, but needs to be addressed, particularly as general practice systems move to being able to receive structured coded messages.