111 Referral Standard: Final Report

The concerns raised during consultation can be mitigated via:

1. Implementation guidance – which will reference that information captured is ‘mandatory’, ‘required’ or ‘optional’. Very little information in the standard is ‘mandatory’, where it is ‘required’ or ‘optional’, it is captured where it is relevant to the individual.
2. Training – implementation of the standard via systems and technology will require some training. This training can reference how the information standard is used in practice i.e. not all information will be relevant.
3. System set-up – ensure that feedback on the layout and format of the PEM is feedback to NHSE and system suppliers who can develop the format based on said feedback
4. The use of the SNOMED CT : - ^1127581000000103 |Health issues simple reference set| when recording the chief clinical concern, has raised an issue over the ability of Primary Care systems to use and record the qualifier associated with a suspected diagnosis e.g. UTI with a qualifier of ‘suspected’. The primary care clinical systems may only bring through the diagnosis of a UTI without the qualifier, causing an incorrect confirmed diagnosis to be recorded. This is mitigated in the hazard log and implementation guidance which make clear that diagnosis qualifiers should not be used in coded form until such time as primary care systems can handle them correctly.

As 111 Pathways (used in England 111 triage systems) is not yet SNOMED compliant, the symptom Group code (SG code) and Symptom Discriminator (SD) code descriptions (terms) will replace Chief Complaint and Chief Clinical Concern when identified by the CAS. The clinician can enter suspected diagnosis in free text.