111 Referral Standard: Final Report

PRSB carried out some initial GP interviews in early 2021 and NHS Digital’s PEM team carried out further discovery work during 2021 with GPs in England gathering feedback on the content and structure of the existing PEM and the processes within general practices on receipt of a PEM. NHS Digital’s PEM report is shown in Appendix 6

The Post Event Message (PEM), received by the general practice following a person's encounter with 111, was brought back into the scope of the PRSB commissioned work in late 2021. PRSB utilised the NHS Digital’s PEM report to support the additional GP focus groups and attended the Joint GPIT committee meeting in Feb 2022 to gather further insight and confirm the information required to flow back to the general practice in the PEM for information.

Two GP focus groups were held with attendees from three of the four nations. The 1st focus group was attended by 12 external delegates, 6 of which were GPs, the 2nd group had 16 attendees with 9 of them GP’s. Each group was taken through the 111 Referral standard and asked which items from the information standard would improve the content of the PEM for information. Mentimeter was used to gather some of the information, from the GP Focus groups.

The Mentimeter outputs are shown in Appendix 7

Key findings included:

• 111 reports are currently received into general practice via ITK Messaging direct into their clinical systems or via email into the document management system.

• 111 Reports can be either ‘For action’ or ‘For information’.

• Local system configuration is required to render the ‘For information’ or ‘For action’ in the document header The current 111 reports received by general practices, are not always clearly distinguishable as either ‘For action’ or ‘For information’.

• This is translated from the sending system and rendered by the receiving system, but this is not consistent across the country. Hence the confusion over ‘For action’ or ‘For information’ within general practices.

• Some suppliers convert the XML coding applied at the provider end for either ‘For action’ or ‘For Information’ into human readable format so that it is displayed when rendered as a PEM in the receiving system. This is not visible to all recipients as relies on local system configuration.

• Local systems determine how the referral and PEM are rendered in a receiving organisation.

• A PEM for information (i.e. not a referral PEM) is processed differently in individual practices across the UK. Some PEMs are directly filed in the person’s general practice record and not read by the GP.

• Generally, the 111 encounter itself is coded to a person’s GP.

• Information within the PEM ‘For information’ is rarely coded into the general practice person record.

• Excluding demographic type data, the key information that should be included in the 111 PEM is as follows:

  • general practice details
  • Individual requirements
  • Safeguarding and risks
  • Referral details (where from, where to and urgency)
  • Plan and requested actions for both the general practice and the person
  • Presenting complaints or issues
  • Chief Complaint
  • Chief Clinical Concern
  • Diagnosis
  • Allergies and allergies (new)
  • Medications and medical devices (new)
  • Clinical summary (following CAS)

• There is an NHS England predefined ‘Never send list’ where a 111 PEM is not sent to the general practice. Discussions with GP’s highlighted that the never send list included some 111 reports that they felt should come to the general practice and as part of the Mentimeter questions GP’s identified when they would not want to receive a PEM. These are shown in the Mentimeter outputs, but are essentially calls which are about finding services or information rather than seeking help on a problem.