How does NHS 111 determine the right course of action for a patient?

When a patient rings NHS 111, the initial assessment is usually with a non-clinical call handler, who has been trained on NHS Pathways, a clinical tool used for assessing and triaging patients, supporting the remote assessment of callers to urgent and emergency services. Depending on the NHS Pathways outcome reached, the call may be passed to a paramedic or a nurse with comprehensive NHS 111 training within the contact centre. There are also a range of other more senior clinicians at hand in the contact centre like GPs and pharmacists to support the NHS 111 team in giving the best care to patients. In the simplest cases, a patient may receive a working diagnosis including self-care advice and a recommendation to visit a pharmacy. The NHS 111 team can also directly book the patient into an appointment at their own GP practice, to be seen at an Out of Hours treatment centre, a Minor Injuries Unit, an Urgent Treatment Centre or, since December 2020, into an Emergency Department. For more serious cases, the NHS 111 team can dispatch an ambulance if required.

But how do NHS 111 call handlers know which services, including pharmacies and mental health providers to direct patients to after the initial assessment – and regardless of whether it is day or night, weekend or weekday? The Directory of Services (DoS) database, a network of healthcare service providers, is integrated into NHS 111 and gives details about which services are closest to the patient’s location based on their clinical need. Call Handlers automatically access the DoS after the initial assessment. If the patient does not require an ambulance or urgent and emergency care services, the call handler can give advice on care options based on the results of information received from the DoS.

Click here to learn more about NHS 111.
The DoS supports HUC and allows HUC to care for our patients by:
• providing up to date information about available services close to a patient’s location at the time of call
The DoS is necessary because it:
• allows our colleagues to book referrals for patient care
• permits us to advise our patients regarding available care services and connect with local providers

The DoS is integrated with NHS Pathways and provides access to services across England. Our call handlers input patient information into the system based on the answers patients give, which then decides the outcome based on the details provided. But it is much more than a software. Our Call Handlers also receive comprehensive training over a number of weeks on NHS Pathways but also on probing, spotting red flags and managing challenging situations, which is refreshed at regular intervals throughout their service.

At the end of an assessment and based on other factors including age, location, registered surgery, and presenting symptoms, the DoS will recommend appropriate local service referrals if required.
As a result of our training, the DoS and NHS Pathways, we’re confident that when a potential patient connects with one of our Call Handlers they will receive timely, efficient and effective care advice that is only moments away from their homes and families.

Click here to learn more about NHS Pathways.
What happens if a health care provider is not available?
In circumstances where the closest service to the patient’s location is currently unavailable, an alternative relevant service will be identified by the DoS. In rare cases where there are apparent gaps, our colleagues work closely with our commissioners who will then review that case for the region they are responsible for.

What happens if a patient can’t call NHS 111?
Sometimes patients, their family members or carers may not be able to contact NHS 111 over the phone or prefer a different way of doing so. In cases such as this, they can access NHS 111 via the online service. This permits patients to “walk through” an assessment similar to that of what they would receive from our colleagues over the phone. After verifying that the patient does not need to contact 999, the online assessment will then connect them with appropriate care. This may include self-care advice, an appointment at a relevant service or a call back from one of our clinicians in the contact centre.

Patients should contact 999 if they have the following symptoms:
Call 999 now if you have:
• signs of a heart attack
• signs of a stroke
• severe difficulty breathing
• heavy bleeding
• severe injuries
• seizure (fit)
• sudden, rapid swelling

If you are interested in learning more about the DoS, visit this website.