As a GP, should I receive a PEM for every call to NHS 111?

A PEM will be received by the GP surgery from NHS 111 if the outcome was ‘For Action’ - this means that the patient has been told to see their own GP.

GPs will receive a PEM at the end of every call to NHS 111, except in the following circumstances:

• a patient is referred to OOH by NHS 111, the GP will receive a PEM from the OOH service - this prevents duplication and since being implementated has already resulted in a significant reduction in PEMs to GPs.

• the outcome is on the 'Never Send Disposition' list - NHS 111 systems should suppress all PEMs for the dispositions in this list.

The current 'Never Send Disposition' list is:

DX 28	Contact Pharmacist
DX 52	Refer to Police
DX 60	Contact Optician next routine appointment within 72 hours
DX 22	To be seen by Dental Practice within 3 working days
DX 23	Contact Orthodontist next working day
DX 45	Provide Service Location Information
DX 46	Refer to Health Information
DX 63	Refer to Fluline

Given the nature of these referrals, PEMs can be safely suppressed without introducing clinical risk.

In practice the proportion of calls which fall into these disposition categories is small (approx. 1.9%) and so the reduction of the number of PEMs sent to GPs also low.

This list is reviewed as part of each NHS Pathways version release by the Regional Clinical Leads.

Why doesn't 111 just use the same system that Out of Hours messaging does?

NHS 111 is a nationally available number and while routing calls is very accurate it is not always the case that a GP’s patients will be handled by the local 111 service. OOH PEMs do not have a consistent data structure or carrier mechanism, which means the system cannot simply be ‘scaled-up’ to deal with NHS 111 messages.

Why are calls sometimes routed to the wrong area and provider?

This can be due to fuzzy borders between mobile masts, recently installed mobile masts that have not yet been assigned to the correct geographical area, and other environmental factors which cannot be controlled.

Calls may also be routed differently during times of peak load, or if a particular areas has a temporarily reduced capacity for receiving calls into their usual providers.

Will I still receive a PEM message if the patient has been directed to me for onward care?

See As a GP, should I receive a PEM for every call to NHS 111?

Why am I receiving Faxes?

A practice may receive a fax if they are not using ITK or NHSMail, or if a practice's patient is handled by an out of area 111 service. The service handing the call will always obey the DOS and a lookup will occur, and if there is an ITK endpoint or and NHSMail email address it will adhere to it.

In the event that neither ITK or NHSMail are returned from the DOS the out of area service will not know about any local configurations that may exist. This leaves the service little option to meet its NQR requirements and they will typically fax a version of the PEM to the practice.

Faxes can also occur in the event of a technical failure from local 111 services as a contingency mechanism.

Why am I receiving different versions of PEM?

If a practice is using ITK then all PEM will be consistent as every 111 service will adhere to it.

If a practice is using NHSMail, then it is up to the sending service to render that message before it is transmitted. The local version of that renderer may have deviated from the national standard. It is possible for practices to choose to deviate from the national standard. However, they should understand that doing this will mean that dealing with out of area calls from other practices is harder.

The choice of whether faxing is used is made by local services and varies across the country. 111 systems may also give the call handler choice of whether to use it, and this can introduce error.

Variance and choice is part of the fundamental standard. The recommended approach is that messages should first be received via ITK, as this will have no impact on any other service. At that point practices can vary their approach to handling PEMs.