111 Referral Standard: Final Report

Mental Health Focus Groups (RC Psych & BPS)

The Royal College Psychiatry raised a concern over the ability to record and share all medications a person may be taking when using the standard. Their concern was regarding medications that may be being prescribed by mental health trusts (e.g. clozapine / depot antipsychotics), but may not be recorded within the general practice record. The RCPsych suggested the inclusion of any ‘over the counter’ and ‘medications’ bought online that the person maybe taking. Some medications bought online or over the counter relate to contraindications with a person’s prescribed drugs and risks of overdose for mental health presentations.

The implementation guidance was updated to include the recommendations for the capturing of medications known be taken but not recorded in the general practice record.

Dentistry Focus Groups (BDA & OCDO)

The BDA policy team responded to the survey and engaged with the additional focus groups.

Dentists do not yet have access to shared care records, but increasingly it is noted that dentists require specific information about a person referred from 111. Individual requirements and in particular; obesity/bariatric (fit in dentist chair), anxiety, other mental health conditions, impairments would be helpful before treating a person.

The OCDO who are working closely with the PODAC programme (which includes the 111 referral) have highlighted that when a person calls 111 with an oral health issue the call is transferred to a 111 dental call handler. To ensure the person’s own dentist is updated with any treatment or advice from the 111 service it has been suggested that the 111 referral standard should include a section to capture the person’s registered / usual dentist (if they have one).

The standard was updated to include a new section for Dental Practice (based on the existing GP Practice section.

Community Pharmacy Focus Group (RPS)

Many pharmacies now have access to the Summary Care Record or GP Connect record viewer so are able to view some general practice information to support the direct care of an individual. As part of the discussion with RPS it was noted that ‘new’ Risks were not in the 111 Referral standard. This was taken back to the project team as an omission and ‘risks’ were added in to the Standard. Risks, currently can be added as free text or when SNOMED compatible, the standard will look to the SNOMED coding to capture any ‘new’ risks identified. To ensure there is no ambiguity as to whether there are risks or not, the standard mandates that the risk element requires a response so the 111 call handler or CAS clinician needs to state if there are ‘no known risks’

Optometry Focus Group (College of Optometrists)

Many optometry practices in England are, and increasingly, offering urgent/emergency eye care services. These are commissioned locally but not consistently as yet across England. Local NHS111 Teams should be aware of these urgent/emergency commissioned services in optometry practices and the mechanisms to communicate with them, the provision of which will vary locally including how they receive referrals. The 111 Referral standard would support the digital communication between 111 and optometry. This is expected to be delivered by the PODAC program.