Urgent routes, safeguarding and third-party concerns

Crisis contacts must reach a person or service that will take responsibility. Depending on wording, setting and local protocol this may be the duty clinician, NHS 111 mental health option in England, NHS 111 Wales option 2, NHS 24 111 mental health option in Scotland, a local crisis team, Northern Ireland Lifeline, 999, safeguarding teams, a domestic abuse pathway, the police or another emergency route.

The receptionist's role is to activate the agreed route, not to hold clinical risk while deciding what should happen. When children, dependants, domestic abuse, exploitation, weapons, violence or inability to make contact are involved, follow local safeguarding and emergency procedures as well as mental health pathways.

Common escalation routes

• Duty clinician: for urgent clinical ownership within the practice when local protocol requires it.
• 111 mental health or local crisis route: for urgent mental health support where this is the agreed pathway in the relevant UK nation.
• 999: for immediate danger, overdose, serious injury, violence, weapons, collapse or life-threatening concerns.
• Safeguarding routes: where children, dependants, domestic abuse, neglect, exploitation or coercion may be involved.
• Manager or senior support: when there is refusal, conflict, uncertainty, failed contact or an unclear route.

Do not let the route stall

Escalation must result in someone taking ownership. A message left unseen in a task list, an online request waiting in a queue, or a note added without confirming who will act may be insufficient for crisis wording.

Third-party contacts can be challenging because the patient may not be present or may not have consented. Follow local information-sharing and safeguarding processes. If there are serious concerns about immediate safety, escalate rather than dismiss the report because details are incomplete.

Local wording

Crisis escalation is only safe when the contact has a clear owner and any safeguarding concern has not been left unresolved.