Pressure in our system


Dear GP Colleague,

Pressure in our system

I am writing this correspondence at a time when I know that the demands on general practice services are at unprecedented levels due to COVID and the ongoing consequences of the pandemic.

We are working hard to direct more people, where appropriate to do so, to our pharmacies to alleviate the pressure on our system, including on our General Practice and UTC’s.

All of NEL Urgent Treatment Centres are also seeing unprecedented levels of demand.

We have been advised this afternoon that London Ambulance Service has reached REAP Level 4 which means that LAS are under ’extreme pressure’. Our NEL 111 Clinical Assessment Service is also under pressure with 40% of calls now above planned activity levels. This means that we have a large queue of people waiting to be assessed in the clinical assessment service which presents clinical risk.

Some of the actions that we would like your help with to alleviate some of the 999 and 111 pressure are the following; 

  • To check all answerphone messages to review whether 111 online is recommended before calling 111, UTC or EDs. We would appreciate if this could be changed (with worsening advice) to direct people to 111 online, if this is not currently the case.
  • To prioritise answering bypass numbers from the 999 service. This will enable either a call to be closed by the ambulance service or release an ambulance crew from a patient’s home so they can assess another patient as quickly as possible.
  • We would appreciate if you could also check the number of slots you have available for 111 to book into and that this meets the 1 slot per 3,000 levels. Please make these slots available throughout the day rather than first thing in the morning – ideally between 11am and 6pm.

We do understand that there has been some concern about the appropriateness of some of these booked slots and we are seeing a great deal of low acuity within the demand for all of our services including GP Practices and UTC.

In order to gather some further evidence on any inappropriately booked slots we would appreciate if you could send the case numbers through to John Light John.light7@nhs.net and Sanjit Deo Sanjit.deo@nhs.net  both from LAS 111 CAS service. This will help us to continually improve the types of referrals that GP Practices are receiving from 111 and which can be resolved through pathways or at a local NEL level.

I do know the pressure you are under and I appreciate the levels of sustained hard work that everyone is experiencing in this unprecedented time.

Once out of this crisis we will need to seek longer term solutions if demands for all our services are to remain high.       

With warm wishes

Mark Rickets