111 Referral Standard: Final Report

The 111 Referral standard has been developed over a four-year period through several commissions and phases, as summarised below, and in accordance with the proven, established, and trusted PRSB methodology involving UK wide consultation.

In 2018 PRSB were commissioned by NHSE to set out the high-level information requirements for a 111 clinical assessment service. The work included research and evidence gathering of existing guidance, current practice (examples of current records and communications, output from clinical decision support systems), and relevant related projects and standards. Draft requirements were developed from this and then refined through a multi-disciplinary workshop with health and care professionals, patients and system suppliers.

Urgent care workflow report and requirements are referenced in Appendix 1

In 2021, PRSB conducted discovery work to validate the previous high-level requirements from 2018 and recommend the work needed to develop a 111 referral standard. This work:

• Validated the 2018 requirements with the addition of a few data items
• Concluded that the proposed standard could work for 111 referrals from call handlers and 111 online, although some information would only be available where there was contact with a clinician.
• Concluded that a general practice post event message (PEM) should be developed alongside the 111 referral standard as it is expected to be subset of the referral information and consultation will involve many of the same stakeholders.

The discovery phase report is referenced in Appendix 2

In August 2021 a short commission delivered a draft information model from the outputs of the discovery work to support pilots for BaRS for 111 to emergency departments (ED). The 111 referral information model V0.2 was provided for this purpose, validated by the same project team from the discovery work, working with NHS Digital and NHSX and using existing PRSB standards components wherever possible for consistency with other standards and FHIR profiles.

Starting in October 2021 PRSB completed the development through;

• Wide consultation through a survey for users of services, senders and receivers of 111 referrals to gain consensus and support for the standard and test it across the many different destination communities including with IT providers and system suppliers. This was followed up with specific engagement with areas with lower numbers of survey responses (dentistry, optometry, mental health and community pharmacy) to verify the draft 111 referral standard was suitable for those areas.
• Verifying that 999 services could provide the essential information of a 111 referral and therefore be included into scope of the standard.
• Engagement with GPs through interviews and focus groups to define the general practice PEM.
• Further work is delayed to May/June 2022 to gather and analyse feedback from the 111 to ED pilots and update the standard as appropriate.