This information is intended to address some of the common misconceptions about the NHS Pathways Capacity Management System (CMS) programme. Not every aspect of NHS Pathways CMS is covered, so if you have additional issues you would like to address please email the team nhspathwayscms@nhs.net

1. NHS Pathways requires a full system change
2. Call handlers only get two hours training before they use NHS Pathways
3. The call length for NHS Pathways is longer than for other systems, meaning that patients have to wait on the phone longer
4. You can't re-triage with NHS Pathways
5. NHS Pathways causes most patients to be sent back to a GP
6. NHS Pathways and NHS 111 are the same programme
7. Integrated care pathways and NHS Pathways – are they the same thing?
8. The Capacity Management System (CMS) is just a Directory of Services
9. There is a charge for using NHS Pathways
10. Call handling data, case records and triage records do not need to be provided to the central NHS Pathways team once ownership of CQI (continuous quality improvement) has been transferred to an NHS organisation
11. Using NHS Pathways increases referrals to Ambulances
12. NHS Pathways is just one group's view of how triage should be done, there is minimal clinical input and it is not supported by anyone
13. You have to answer all of the questions, every time even when you know what the patient has rung about.  You cannot quickly get to the relevant questions for 'cough' without asking lots of unnecessary questions about gun-shot wounds
14. NHS Pathways and the Directory of Services (DOS) are separate products and the DOS can be used with any other triage software
15. NHS Pathways can only be used by non-clinical call handlers
16. Nurses are no longer required for telephony-based triage as NHS Pathways can be used by non-clinical call handlers
17. Alternative providers have a proven shorter call times and lower numbers of referral to ambulances for NHS 111 calls

Myth: NHS Pathways requires a full system change.

Fact: This is incorrect, NHS Pathways is a clinical assessment tool that sits within a host system an organisation already had in place.  The technical specification to enable the embedding of the NHS Pathways content within a system is available to any supplier that wishes to sign the License.  No organisation has to change its infrastructure to enable access to NHS Pathways.

NHS Pathways does require careful mapping of revised workflow associated with enabling assessment and referral to definitive care for 80% of caller on first call (99.5% for 999 calls).

Myth: Call handlers only get two hours training before they use NHS Pathways.

Fact: Any call handler using the NHS Pathways to answer calls receives a pre-course learning pack which provides an introduction to the system and key areas of anatomy, physiology and medical terminology. Followed by 60 hours of classroom tuition, written and practical assessments which must achieve a pass mark of 70%, plus at least four weeks of supervised use and a further review period to assess performance during live use.  This includes a clinical audit of calls taken and direct feedback to the individual.

This is in addition to any training provided by the organisation on use of telephony, call control and local processes and procedures for call referral under different circumstances, such as child protection, vulnerable adult, frequent caller or patient with special notes.

Myth: The call length for NHS Pathways is longer than for other systems, meaning that patients have to wait on the phone longer.

Fact:  Comparisons of call length between different systems needs to compare the entire episode of calls within the organisation.  So if a call is opened by a call handler, and transferred to a nurse for completion then both call lengths need to considered. 

In the 999 setting, more than 99.5% of calls are closed by the call taker, with between 15-20% of 999 calls referred to a non-ambulance disposition.  Accurate comparison with other 999 call handling systems need to include the call length associated with low priority calls placed in a queue for clinician ring-back and re triage to definitive care.

With NHS Pathways, in an urgent care environment, around 80% of calls are opened and completed by the call handler, with an average call length of between 5-7 minutes.  Some of the variation comes from how NHS Pathways has been embedded within the host system and the implications for call flow, and operational system use for call length.

Myth: You can't re-triage with NHS Pathways.

Fact: With NHS Pathways you can re-triage a patients symptoms as many times as you want or need.  However, the aim of NHS Pathways is to provide an effective triage tool that provides patients with the right care first time. If there is an operational model at a local level that demands certain calls be re-triaged then NHS Pathways can do this, but use of the tool generally means that no re-triage is necessary.

However, the NHS 111 specification sets some clear service requirements, including 'no re-triage' and anticipates that patients will not face multiple assessments from different services.

Myth: NHS Pathways causes most patients to be sent back to a GP.

Fact:  NHS Pathways refers callers to whatever range of services have been populated in the local directory.  For NHS 111 calls, around 45% of callers are referred to see or speak to a primary care service of some kind, including GP routine appointment, GP out of hours appointments, GP same day appointments, minor injury units, walk in centres, urgent care centres, and other community based services.

Myth: NHS Pathways and NHS 111 are the same programme.

Fact: Not true; NHS 111 is a policy initiative for improving access to urgent and emergency care, whereas NHS Pathways is a clinical assessment tool that may be used to assess calls to a range of different NHS numbers such as 111 services, 999 services, GP out of hours or NHS Direct.
Use of NHS Pathways is not mandated, but to date all NHS 111 sites have elected to use NHS Pathways and the integrated Directory of Services (DOS) as their clinical assessment and referral tool.

Myth: Integrated care pathways and NHS Pathways – are they the same thing?

Fact: No, integrated care pathways are treatment paths for patients with particular conditions or illnesses, which mostly take place in a secondary care environment.
NHS Pathways assesses symptoms reported over the phone (e.g. 999 or 111 calls) by the patient in a one-off exchange and gives them the best course of action at the time.  Patients may enter an integrated care pathway after their interaction with NHS Pathways and when they access primary or acute care services for treatment.

Myth: The Capacity Management System (CMS) is just a Directory of Services.

Fact: The Directory of Services (DOS) is just one module in the CMS suite.
• There are additional modules including: Overall Hospital Activity – an indicator which takes data from points within an acute or community unit and provides a score of relative 'busy-ness', which allows commissioners and winter/emergency planners to review relative capacity across an area at a glance.
• Critical Care Bed Status – a web-accessible record of the critical care beds available in Critical Care Units across England.  This supports clinicians to locate an available bed and make fewer phone calls to seek a vacancy into which a patient can be referred.
• Paediatric Critical Care Status – as above but for paediatric critical care beds.
• 999 rerouting.

Myth: There is a charge for using NHS Pathways.

Fact: At present the License to use NHS Pathways and the Directory of Services (DOS) is provided free to the NHS.  Services wishing to adopt NHS Pathways do need to make provision to pay for training of their in-house trainers, and provision of local implementation/project management support to manage the local workflow configuration and change management associated with implementing NHS Pathways.

Myth: Call handling data, case records and triage records do not need to be provided to the central NHS Pathways team once ownership of CQI (continuous quality improvement) has been transferred to an NHS organisation.

Fact: This is not true; the License to use NHS Pathways which is signed by any organisation using NHS Pathways to deliver NHS commissioned services requires provision of specified data on a monthly basis as an essential part of system performance monitoring for the central team across the board.  This helps inform improvements to future releases of NHS Pathways. This data should be sent to the central team for the lifetime of the NHS Pathways clinical content within your host system. 

Myth: Using NHS Pathways increases referrals to Ambulances.

Fact: There is no evidence to suggest that this is the case; an increase in ambulance referrals is more likely to be due to seasonal impacts, local operational categorisation or just national peaks. There have been two interim evaluation reports conducted on the 111 pilots at Durham and Darlington and neither of these indicated any escalation of Ambulance referrals as a result of NHS Pathways.   In fact, the second interim evaluation report reported a decrease in low priority ambulance dispatches.

Myth: NHS Pathways is just one group's view of how triage should be done, there is minimal clinical input and it is not supported by anyone.

Fact: NHS Pathways was created and is maintained by a group of highly experienced clinicians, with strong track records in GP out of hours, urgent care delivery and telephone triage.  It is independently governed by group chaired by the RCGP, with representatives from BMA, CEM and various other colleges and professional bodies involved in urgent and emergency care.

Myth:  You have to answer all of the questions, every time even when you know what the patient has rung about.  You cannot quickly get to the relevant questions for 'cough' without asking lots of unnecessary questions about gun-shot wounds.

Fact:  NHS Pathways clinical structure has been very carefully set to maximise clinical safety and operational appropriateness.  The initial questions support identification of life threatening conditions, but all call handlers are taught that they must answer every question but they do not have to ask every question.  For example:  if a caller is ringing about their cough and is quite clear that is the only issue they have, and is talking normally, it is possible click through screens asking about life threatening haemorrhage and arrive at the Body Map, where the symptom specific selection can be made to support speedy triage of the reported cough.

Myth: NHS Pathways and the Directory of Services (DOS) are separate products and the DOS can be used with any other triage software. 

Fact: They are two separate products but work best when integrated with one another.  The Clinical data within the DOS can only be searched automatically when it is integrated with Pathways, otherwise the DOS must be search manually by a clinician, either directly, or via a clinician instructing a call taker on the clinical search parameters to be manually entered. 

NHS Pathways with the integrated DOS is the only tool that provides a fully integrated clinical assessment and referral. Both products are owned by the Department of Health and no other triage software can link to the clinical data within the DOS in the same way that NHS Pathways does. 

Myth: NHS Pathways can only be used by non-clinical call handlers

Fact: This is incorrect; the NHS Pathways clinical assessment can be used by anyone trained on it, this includes call handlers, nurses, paramedics, etc within the call handling / telephone triage process.  

Myth: Nurses are no longer required for telephony-based triage as NHS Pathways can be used by non-clinical call handlers. 

Fact:  NHS Pathways can be used with whatever staff skill mix is chosen locally.  This can include trained lay call handlers handling some calls, and referring others to nurses, or nurses can answer all calls themselves.  There is no proscribed skill mix required to implement NHS pathways.  There is however a requirement for clinical supervision with the call centres, and a clear obligation under the license for use of NHS pathways to provide clinical audit and clinical-quality supervision of all users of the system.

Myth: Alternative providers have a proven shorter call times and lower numbers of referral to ambulances for NHS 111 calls.

Fact: Only NHS Pathways is being used to assess live NHS 111 calls. To date, DH has not accredited any other systems and until live pilots have been implemented and the data evaluated it is not possible to compare alternative system data with existing NHS 111 pilots with any accuracy.