Urgent routes and local pathways

Possible sepsis must be passed straight to someone who can take clinical responsibility. Depending on the wording, setting and local process, that may be the duty clinician, 999, NHS 111 or local urgent care, maternity triage, an urgent community response route, or another agreed pathway.

The receptionist's role is to activate the agreed route, not to hold the risk while deciding clinical care. Escalation should result in a named person or service accepting responsibility for the next step.

Common escalation routes

• Duty clinician: for urgent clinical ownership within the practice when local protocol specifies this.
• 999: for suspected life-threatening emergencies, using approved local wording.
• NHS 111 or local urgent care: where the concern is urgent but not immediately life-threatening.
• Maternity or early pregnancy pathways: for infection concerns in pregnancy or recent pregnancy.
• Care-home or community response routes: where local arrangements allow urgent review in the community.
• Manager or senior support: when there is refusal, conflict, uncertainty, failed contact or no clear route available.

Do not let the route stall

An urgent message left unseen in a task list is not a safe escalation. Staff should know who has accepted ownership, what to do if no one responds, and how to manage a patient who refuses the recommended route.

If a patient or caller resists urgent escalation because they want a GP to assess first, follow the local process. Record the refusal, the exact wording used, any advice or escalation offered, and who was informed.

Manager/process detail

Escalation is only safe when urgent wording has a clear owner and has not been left in routine workflow.