111 Referral Standard: Final Report

It is well known that the NHS services across the UK are under real pressure with demand outstripping supply. The pressure has recently been exacerbated by the pandemic but also exacerbated by patients not being seen in the services appropriate for their needs. Across the UK, 111 services are becoming the first point of contact for urgent care with the aim to direct patients to the most appropriate service for their needs.

England’s NHS Long Term Plan sets out to ensure patients get the care they need, fast, and to relieve pressure on A&Es through referring patients to the most appropriate service, which could include urgent treatment centres, same day access services, general practice primary care based services, or other services such as community, mental health, community pharmacy, dentistry or optometry. In some cases the 111 services would have the ability to book slots or appointments with the receiving service.

Currently in England, a 111 report can flow to the receiving organisation using an Interoperability Tool Kit (ITK) message. This report is based on the summary of decision points from the triage algorithm and reads poorly by clinicians on the receiving end – it lacks clinical value by not using a language that clinicians are trained to use. The same ITK message is used to inform the person’s general practice of the 111 encounters, this is known as a post event message (PEM) or 111 report for information.

The NHS bookings and referral standard programme (BaRS) is working to develop both a booking and referral standard for 111 referrals to support the needs and policy, and which can be implemented using FHIR (Fast Healthcare Interoperability Resources) technology which is the current NHS standard and being widely adopted across health and care. The PRSB is providing the 111 referral content standard.

PRSB have developed the 111 referral standard to provide clear, concise and effective information for the 111 referral along with a post event message (PEM), a subset of the referral, to inform the person’s general practice.

The standard will provide clear, easy to use information that can be shared with the receiving clinician or professional so they can provide appropriate, efficient, effective, and safe treatment to the person. It allows for the sharing of the clear reason for the referral to allow a safe transfer of care. The presenting need (as identified by the person), the chief complaint (identified either through the triage process or by a clinician) and the chief clinical concern or a diagnosis where there has been assessment by a clinician. The standard will give people confidence that information they provide is passed on to next stage in their journey so they don’t have to repeat it all each time.