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Coronavirus: NHS patient triage hotline stops nurses handling calls over safety fears

Exclusive: Nursing and non-medical staff stopped from taking calls after more than half of those audited were unsafe

Shaun Lintern
Health Correspondent
Tuesday 18 August 2020 08:20 BST
The Covid-19 Clinical Assessment Service has stopped nurses and other clinicians from taking calls from patients due to safety concerns
The Covid-19 Clinical Assessment Service has stopped nurses and other clinicians from taking calls from patients due to safety concerns (Getty)

Nurses and non-medical staff have been stopped from taking patient calls to the NHS coronavirus helpline amid concerns over the safety of their advice.

An audit of calls to the telephone assessment service found more than half were potentially unsafe for patients, according to a leaked email shared with The Independent.

At least one patient may have come to harm as a result of the way their assessment was handled.

The Covid-19 Clinical Assessment Service (CCAS) is a branch of the NHS 111 phone line and is designed to assess patients showing signs of coronavirus to determine whether they need to be taken to hospital or seen by a GP.

The helpline was set up at the start of the pandemic to divert patients with symptoms to a phone-based triage to relieve pressure on GPs and prevent them from turning up at surgeries and spreading the virus.

GPs, nurses and allied health professionals (AHPs) such as paramedics and physiotherapists were recruited to speak to patients after they were flagged by NHS 111 call handlers.

The use of non-medical staff was first paused in July amid concerns about the quality of call handling.

Now it has emerged much wider safety issues have surfaced.

In a message to staff on Friday, Enid Povey, the clinical assurance director for the National Pandemic Response Service, told staff: “Following pausing nurses and allied healthcare professionals working on the CCAS in order to strengthen the training requirements for this cohort of staff, we have undertaken a further round of call audits of nurses and AHPs as agreed.

“Since pausing, we have listened to a significant number of calls and so far over 60 per cent of calls have not passed the criteria demonstrating a safe call.

“Unfortunately, these call audits resulted in a number of clinical incidents having to be raised. These incidents are currently being investigated, with one escalated as a serious untoward incident with potential harm to the patient.

“We have therefore taken the difficult decision to continue to pause all nurses and AHPs working on CCAS.”

More than 1,000 GPs have signed up for the service, including retired staff and agency workers, as well as NHS employees.

One worker in the service said they were worried staff who may have been out of work before joining would not be making enough calls to keep their skills up to the standards required.

They added: “I don’t know what has happened to create the current problem. I can only surmise it’s clinical decision-making that is incorrect and not being flagged to a senior manager when it should be.

“There is support available. Maybe some overconfidence on the part of some clinicians.”

When a patient calls NHS 111 and meets certain criteria, they will be referred to CCAS where a clinician carrying out the assessment will access their GP patient record remotely. The patient could be offered an appointment to see a GP face to face, or they could be monitored by phone and given advice during self-isolation.

The sickest patients will be sent to hospital by ambulance.

The message to staff said the CCAS was looking at additional training, but until that was finalised no staff will be signed off to return to work the paid shifts.

It added: “No further shifts will be allocated at present, and any confirmed shifts or audit shifts will be cancelled.

“We do fully appreciate the impact this will have on you and we did not make this decision lightly, however, we hope you will support us in putting our patients’ safety first while we scope out what additional support can be offered. Patient safety is our top priority in reaching this difficult decision.”

South Central Ambulance Service NHS Foundation Trust, which runs the CCAS service said: “CCAS has played a vital role in helping over 165,000 patients in our local communities receive first class care and will continue to be delivered by GPs and other medical staff, while we continue to provide additional training for nurses and AHPs, to support CCAS in the future.”

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