Covid-19: Changes to NHS 111 IUC escalation and system mitigation actions

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Given the prominence of the Omicron variant in London and the known rapid rate of transmission, revised NHS 111 Integrated Urgent Care (IUC) escalation and system resilience mitigations have been agreed for London, on a temporary basis. 

The temporary revisions relate to changes to 111 dispositions and are designed to manage demand surges and limit pressure on the wider Urgent and Emergency Care system, including Primary Care, EDs and UTCs. The aim is to improve 111 call response, reducing caller abandonment levels and reducing pressures on IUC CAS services allowing clinicians to respond to patients requiring urgent assessment, as well as protecting LAS 999 and emergency department services. 

The changes to 111 dispositions will only be enacted if pressure on the 111 service escalates (to level 3 as described in the accompanying slide), with the current dispositions remaining the default position if service pressure and demand does not escalate.

The CCG wanted to highlight two particular mitigations that will impact primary care colleagues, if enacted, including GP extended access, GP OOH and p;ractices. The intention is to maximise use of primary care slots held for 111 across all primary care services.

If a 111 IUC Clinical Assessment Service (CAS) triggers escalation: 

  • for 111 calls with an outcome of ‘To contact a Primary Care Service within six hours’ (DX 06)
    • 111 will enable these calls to be booked into any same day Primary Care slot (GP practice or extended access hub)
    • under 5s and over 65s will be excluded and all callers will be given safety-netting worsening advice to call 111
  • for 111 calls with an outcome of ‘To contact a Primary Care Service within two hours’ (DX 05),
    • 111 will enable these calls to be booked into any same day Primary Care slot within 4 hours
    • under 5s and over 65s will be excluded and all callers will be given safety-netting worsening advice to call 111

In NCL, our 111 provider London Central and West Unscheduled Care Collaborative (LCW) will adopt the new NHS 111 IUC Winter Escalation Plan with immediate effect and prepare to deploy mitigation actions in line with escalation triggers to improve overall response and resilience.

The CCG wants to assure you that these decisions have not been taken lightly and senior NHS England clinical colleagues are aware that some of the mitigations are outside of the current NHS Pathways Licensing requirements. However, the mitigations have been carefully assessed against the clinical risk of current 111 IUC pressures, the wider regional UEC pressures currently experienced by London 999 and emergency departments.  

To mitigate potential impact on primary care The CCG is also increasing Extended Access Service capacity, which is hoped will maintain resilience should the need arise to trigger implementation.


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Expiry date: Feb 24th, 2022