111 Referral Standard
Across the UK, 111 services are becoming the first point of contact for urgent care and are essential in ensuring that people are referred to the most appropriate service safely and efficiently. In England the NHS Long Term Plan sets out to ensure patients get the care they need, fast and to relieve pressure on A&E departments by referring people to the most appropriate service.
The PRSB has created a standard to support clear and concise information flows between the 111 referrer and the receiving services and professionals or clinicians to support safe and effective care.
Current release
Version: V1.0 | |
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Release date | April 2023 |
Release notes | 
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Next release date | Jan – March 2026 |
Next release type | Scheduled release |
The standard | |
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111 Referral Standard documentation | |
Full standard – PRSB viewer | 
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Full standard – Excel | 
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Full standard – Json | 
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GP post event message (PEM) documentation | |
Full standard – PRSB viewer | 
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Full standard – Excel | 
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Full standard – Json | 
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Minimum Viable Information Standard (MVIS) | MVIS sets out the data items and business rules that must be implemented to achieve safe, minimum implementation . Read more > |
Supporting documentation | Description/purpose |
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Information standards notice (ISN) | ISNs are published to announce new or changes to information standards published under section 250 of the Health and Social Care Act 2012. |
| This document includes general implementation guidance for all PRSB standards. Detailed implementation guidance specific to this standard are included within the information model. |
| Rules for implementation of the standard. |
| Describes the purpose, methodolgy and stakeholder engagement for developing the standard, along with the findings and recommendations for further work. |
| Summarises the hazards which could result from implementing the standard. |
| Details the potential hazards from implementing the standard with their risk rating and mitigation. |
Provenance data | Defines the information on who made a record entry and who carried out the activity, where and when. |
Need implementation support?
- Online support form
- Support@theprsb.org
- 020 4551 5225 (9-5 Mon-Fri, excl. bank holidays)
About this standard
PRSB was commissioned by NHS England to produce the 111 Referral Standard as part of the Booking and Referral Standard programme (BaRS). The standard defines the information that should be shared from 111 or 999 services when a person is referred onto another service. It also defines the information for a post event message (PEM) to inform a person’s GP of their contact with 111 services.
This is subset of the 111 referral to give GPs an effective summary, and is sent after all contacts with a few exceptions, including if the referral is to the GP, or the call was just to seek information. GPs should not confuse this PEM, which is just for their information, with a 111 referral to GP, which they must action. These will replace the current referral messages which are poorly regarded and little used.
Scope
The standard applies to:
- All 111 and 999 service referrals to wherever the person goes next.
- Referrals through 111 online, call handler or clinical assessment services and 999 services, and is not specific to any triage system.
- The standard is UK-wide and developed in consultation with a wide range of professionals from all four nations, including from 111 services, receiving services, IT suppliers and people who use services.
- All age groups including children.
The standard does not apply to transfers between 111 services (e.g. across a country border) or between 111 and 999 services.
How it works
The standard defines the full set information which should be sent in a 111 referral, however some of the information will only be appropriate when the referral is from a clinician or the clinical assessment service (e.g., the chief clinical concern or the diagnosis).
These occurrences are noted in the implementation guidance and supported by the conformance (mandatory, required or optional) for each data item, where required means the information should be sent where it is available, recognising that this information may not be available where its not relevant to the individual case or not gathered during calls or online contact.
Much of the referral information should be generated from the system with the information recorded during the contact, with only information like the clinical summary (where used) having to be added by the referring person. This is illustrated in the examples available below.
The table here shows a summary view of the standard.
Please note: Required means the information should be recorded or sent to the general practice where it exists.
Section Name
| Conformance – Mandatory, Required, Optional |
Description
| Included in the GP post event message (PEM)
|
| Person demographics | Mandatory | The person’s details and contact information. | yes |
| Caller details | Required | Name of caller, relationship, telephone number and preferred contact method. For use where the caller isn’t the person needing care or advice. | |
| GP practice details | Required | Details of the person’s GP practice. | yes |
| Dental practice details | Required | Details of the person’s usual dental practice. | |
| Individual requirements | Required | Note that the Individual requirements section includes reasonable adjustment and specific elements for accessible information requirements to support communication. | yes |
| Safeguarding | Required | Any safeguarding concerns identified. | yes |
| Risks | Required | Any risks identified, includes risks to self or to others. | yes |
| Consent for information sharing | Required | This is a record of consent for information sharing under the common law duty of confidentiality. Where consent has not been obtained or sought, the reason why should be provided. Include best interests decision where person lacks capacity. | |
| Referral details | Mandatory | Details of the referral; from where and to where and any person input into the selection. Also urgency of referral, which where the Pathways triage is used is derived from the DX code resulting from the triage process. | yes |
| Presenting complaints or issues | Mandatory | Presenting complaints or issues and the Chief Compliant which is mandatory. Where the Pathways triage is used the Chief Complaint is derived from the symptom group (SD) or symptom discriminator (SG) code resulting from the triage process. | yes |
| Problem | Required | Provides either a diagnosis or the chief clinical concern. These are only likely to be available where there has been a clinical assessment. | yes |
| Clinical summary | Required | A summary of the person’s contact such as reason for attendance, chief clinical concern or diagnosis and actions taken or required. Only likely to be available where there has been a clinical assessment. | yes |
| Social context | Required | The social setting in which the person lives, such as their household (e.g. lives alone), occupational history, and lifestyle factors. | |
| Allergies and adverse reactions | Required | This is for person reported allergies or adverse reactions which may not be on the persons electronic health record. It is NOT to transfer the person’s recorded allergies which the receiver can look up (e.g. via SCR, GP Record or shared care record). | yes |
| Medications and medical devices | Required | This is for person reported medications and medical devices which may not be on the person’s electronic health record. It is NOT to transfer the person’s prescribed medications which the receiver can look up (e.g. via SCR, GP Record or shared care record). The full section has been kept for consistency even if only some of the elements are needed for this use case. This is important for example if the person is taking over the counter medications (e.g. St John’s Wort) bought online or other medications which are not on the person’s record such as mental health medications. | yes |
| Plan and requested actions | Required | The details of any actions or plans for the person (or carer) or the receiving professional. | yes |
| Person and carer concerns expectations and wishes | Required | Description of the concerns, wishes or goals of the person in relation to their care, as expressed by the person, their representative or carer. Record who has expressed these (patient or carer/ representative on behalf of the patient). Where the person lacks capacity this may include their representative’s concerns, expectations or wishes. |
Examples
To give a clearer idea of how the standard works in practice, PRSB have created examples of different scenarios. Each of the clinical settings here show a view of the 111 referral, the GP post event message (PEM), and in some cases, a full model for suppliers.
Further resources
- Implementation update
The Booking and Referral Standard programme (BaRS) is mandated for use for NHS 111 to Emergency Department and NHS 111 to Urgent Treatment Centres (UTC) with both booking of slots in ED and 111 referral information. BaRS has been approved as the strategic solution for booking and referrals and will be implemented widely over time. Further patient journeys such as NHS 111 to community pharmacy or dentistry are planned. For more information on the standard, please see the BaRS website. This includes a list of the future patient or care journeys and technical guidance and specifications for implementation.
- Minimum viability information standard (MVIS)
PRSB information standards define best practice based on evidence and widescale consultation and input from users and stakeholders. PRSB recognises that the NHS and social care are on a journey towards standardisation and interoperability and our aim is to support and encourage implementers on that journey. For this reason, we have defined and clinically validated a ‘Minimum Viable Information Standard (MVIS)’ for each of our standards which represent the minimum safe instance of the standard and delivers the intended objectives within the spirit of the standard. The MVIS defines the data items and business rules which must be implemented in order to have achieved this minimum instance. It is our aim that implementers will continue to improve their implementation of the standard over time and strive for a ‘best practice’ implementation, supported and evidenced by PRSB conformance testing. Please contact our support team to receive a copy of the MVIS for this standard. - Urgent care flows information report
As part of wider plans to improve emergency services in the UK, NHS England is aiming to standardise the information that is recorded and shared by 111 services. This report demonstrates that standardising information allows clinicians to share care records digitally with colleagues in other parts of the health and care system, making care better and safer for patients. - Standards explained
PRSB’s guide to standards which sets out the purpose and benefits of using standards and how to support frontline professionals to adopt them.
- IHRIM record correction guidance
Despite vigilance when filing information in records, mistakes can occur. The Institute of Health Records and Information Management has guidance to support professionals in making corrections following errors.
Endorsement
- Royal College of Emergency Medicine
- Royal College of General Practitioners
- Royal College of Nursing
- Royal College of Psychiatrists
- Royal Pharmaceutical Society
- British Dental Association
- Defence Medical Services
- Urgent Health UK