Using clinician, 111, 999 and local pathways

Escalation should transfer responsibility to the person or service that will manage the patient. That may be a duty clinician, 999, NHS 111, a maternity triage pathway, a mental health crisis service, safeguarding advice or another locally agreed route.

The receptionist’s role is to activate the correct route and provide the information required for that service to take responsibility.

Common escalation routes

• Duty clinician: urgent clinical ownership within the practice when appropriate.
• 999: suspected life-threatening emergency, using approved local wording.
• NHS 111 or local urgent care: urgent problems needing advice or triage outside routine practice appointments.
• Specialist local pathways: maternity triage, mental health crisis teams, safeguarding, palliative care or community services.
• Senior support: use when a patient refuses advice, there is conflict, uncertainty, failed contact or the usual escalation route is blocked.

Check that ownership has changed

Escalation is more than sending a message. The contact must have a clear owner, and staff must know the local fallback if the first route does not respond.

If a patient refuses the advised route, becomes unreachable, or disconnects after urgent wording, follow the local failed-contact or refusal procedure and document the steps taken.

Country and pathway variation

Escalation is only complete when the contact has a clear owner or the failed-contact process has been followed.