General Practice and 111 slots
Dear Colleagues,
Firstly, thank you for all the hard work you do supporting patient care and same day access in North East London. With rising levels of demand these are challenging times for all services and we appreciate how much General Practice does as part of the NEL system.
Further to the recent discussion at the GP Provider Group, and with the whole system under strain we are keen to support the needs of our patients. Keeping them in a primary care setting where possible is where they are likely to receive the best experience for their needs.
In recent years we have seen increasing numbers of NEL residents using 111 rather than their own GP practice as a contact point, both for their urgent and routine health needs. This results in more patients with primary care needs ending up in the urgent and emergency care system, often with multiple touch points and a poor patient experience.
Attached is a list of all the GP practices in NEL and their patients’ in hours use of 111 per 1000 registered population (Data 1st November 2023-30th April 2024). There will be complex reasons why in hours use of 111 by practice patients occurs, but hopefully this is a useful benchmark with surrounding practices.
As you are aware, GP practices, as part of the GP contract, should be making one appointment per 3000 of list size available for those patients who call 111 in hours. These appointments are there to provide a route for 111 staff to get patients to the right place first time if they contact 111 before contacting their practice. They shouldn’t be used by practice reception staff as an overflow option by directing patients to 111 only for them to be subsequently booked into the practice 111 slots. We would be grateful if you could check that this doesn’t happen in your practice.
Due to the pressure on all services, we would like to make use of every available appointment in General Practice. In addition to GP slots, 111 are also regularly referring to the new Pharmacy First scheme.
Across NEL approximately 40 % of 111 slots are booked each day. There is very wide variability of 0-100% utilisation between practices and the most recent data (June 2024) is attached. This shows the percentage of available appointments that are utilised by practice. There will be a range of reasons for this variability, and it would be good for practices, with local knowledge, to review the reasons for this alongside data on their own practice population use of 111.
One common reason for lower utilisation occurs when practices provide specific timed appointment slots which can’t be used once the allotted time has passed. Instead, we would prefer that practices adopt a work list approach which means there are no arbitrary cut offs for booking by 111.
Our suggested option is that practices create a separate work list to support 111/IUC direct booking
Rather than offering fixed timed slots, practices offer a separate appointment book with the number of appointments you have agreed to make available for 111. The 111 service could then book appointments into this separate appointment book without timed appointment restrictions. Practices can then decide how they would like to prioritise and manage these patients based on clinical need.
Timed appointment approach
If your practice prefers to stick with timed appointments, we would ask that you make the first appointment available mid morning e.g. 10am and the rest from 3pm onwards to maximise use.
Housebound patients
In the unusual situation where 111 recognise there is a home visit need, we ask that these requests should be dealt with as if the patient called directly with a home visit request, as the alternative is an ambulance attendance which is often not appropriate. In this situation the 111 clinician will phone the practice team to discuss how best to manage the patient’s needs.
Interaction with London Ambulance Service (LAS)
If your clinical assessment is such that you feel that an ambulance is required for one of your patients, LAS request that you make the call yourself rather than ask your patient or their carer to call. We know that if patients contact 999 themselves (even if a GP has asked them to do so) there is a risk that the 999 service will refer them to 111 for an assessment. This can delay care and can be avoided if a clinician speaks directly to LAS on behalf of the patient.
There is a special Health Care Professional phone line for clinicians where referrals can be made and where the response time needed can be discussed. Please share the attached information where it can be easily accessed by staff.
We hope you will be able to support paramedics in caring for your patients. Evidence shows that continuity of care is best for frail and older patients with co morbidity and that these patients are best managed by a GP / clinician who knows them. This really makes a difference and will prevent unnecessary hospital attendances / admissions.
Once again, many thanks for all the work you do supporting patients.
Attached some practice level data on 111 use, appointment utilisation by practice and information about how to contact the LAS HCP line.
If you have any questions, please do not hesitate to contact usFirstly, thank you for all the hard work you do supporting patient care and same day access in North East London. With rising levels of demand these are challenging times for all services and we appreciate how much General Practice does as part of the NEL system.
Further to the recent discussion at the GP Provider Group, and with the whole system under strain we are keen to support the needs of our patients. Keeping them in a primary care setting where possible is where they are likely to receive the best experience for their needs.
In recent years we have seen increasing numbers of NEL residents using 111 rather than their own GP practice as a contact point, both for their urgent and routine health needs. This results in more patients with primary care needs ending up in the urgent and emergency care system, often with multiple touch points and a poor patient experience.
Attached is a list of all the GP practices in NEL and their patients’ in hours use of 111 per 1000 registered population (Data 1st November 2023-30th April 2024). There will be complex reasons why in hours use of 111 by practice patients occurs, but hopefully this is a useful benchmark with surrounding practices.
As you are aware, GP practices, as part of the GP contract, should be making one appointment per 3000 of list size available for those patients who call 111 in hours. These appointments are there to provide a route for 111 staff to get patients to the right place first time if they contact 111 before contacting their practice. They shouldn’t be used by practice reception staff as an overflow option by directing patients to 111 only for them to be subsequently booked into the practice 111 slots. We would be grateful if you could check that this doesn’t happen in your practice.
Due to the pressure on all services, we would like to make use of every available appointment in General Practice. In addition to GP slots, 111 are also regularly referring to the new Pharmacy First scheme.
Across NEL approximately 40 % of 111 slots are booked each day. There is very wide variability of 0-100% utilisation between practices and the most recent data (June 2024) is attached. This shows the percentage of available appointments that are utilised by practice. There will be a range of reasons for this variability, and it would be good for practices, with local knowledge, to review the reasons for this alongside data on their own practice population use of 111.
One common reason for lower utilisation occurs when practices provide specific timed appointment slots which can’t be used once the allotted time has passed. Instead, we would prefer that practices adopt a work list approach which means there are no arbitrary cut offs for booking by 111.
Our suggested option is that practices create a separate work list to support 111/IUC direct booking
Rather than offering fixed timed slots, practices offer a separate appointment book with the number of appointments you have agreed to make available for 111. The 111 service could then book appointments into this separate appointment book without timed appointment restrictions. Practices can then decide how they would like to prioritise and manage these patients based on clinical need.
Timed appointment approach
If your practice prefers to stick with timed appointments, we would ask that you make the first appointment available mid morning e.g. 10am and the rest from 3pm onwards to maximise use.
Housebound patients
In the unusual situation where 111 recognise there is a home visit need, we ask that these requests should be dealt with as if the patient called directly with a home visit request, as the alternative is an ambulance attendance which is often not appropriate. In this situation the 111 clinician will phone the practice team to discuss how best to manage the patient’s needs.
Interaction with London Ambulance Service (LAS)
If your clinical assessment is such that you feel that an ambulance is required for one of your patients, LAS request that you make the call yourself rather than ask your patient or their carer to call. We know that if patients contact 999 themselves (even if a GP has asked them to do so) there is a risk that the 999 service will refer them to 111 for an assessment. This can delay care and can be avoided if a clinician speaks directly to LAS on behalf of the patient.
There is a special Health Care Professional phone line for clinicians where referrals can be made and where the response time needed can be discussed. Please share the attached information where it can be easily accessed by staff.
We hope you will be able to support paramedics in caring for your patients. Evidence shows that continuity of care is best for frail and older patients with co morbidity and that these patients are best managed by a GP / clinician who knows them. This really makes a difference and will prevent unnecessary hospital attendances / admissions.
Once again, many thanks for all the work you do supporting patients.
Attached some practice level data on 111 use, appointment utilisation by practice and information about how to contact the LAS HCP line.
If you have any questions, please do not hesitate to contact us.
Dr Ben Molyneux
Associate Medical Director
Dr Kate Adams (kate.adams@nhs.net)
Clinical lead 111 IUC NEL
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