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NHS Pathways system update - clinical release note - release 53.2.0

Release 53.2.0 was made available to suppliers and providers on 21 September 2026.

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NHS Pathways make changes to content based on new or emerging clinical evidence, change requests, and feedback from our providers or wider stakeholders.

NHS Pathways identifies areas of content that would benefit from enhancement. The aim of these enhancements is to provide clarity for users, and to benefit both users’ and patients’ experiences, thus ensuring that triage is as safe, effective, and efficient as possible.

The enhancements to Main Telephony made by NHS Pathways for Release 53.2.0 are highlighted below. Release 53.2.0 was made available to suppliers and providers on 21 September 2026.

What we've changed

Pre-determined management plan

NHS Pathways have made significant changes to the Pre-determined Management Plan (KFC) pathways.

Changes are intended to safely amend the number of calls reaching a ‘Speak to Primary Care Service within 1 hour’ outcome, when patients have been told to ‘contact the doctor’.

Changes made

The following 3 new questions must receive a ‘Yes’ answer to enter the Pre-Determined Management Plan pathway:

  • ‘Is the call about a KNOWN health problem?’
  • ‘Is there a FIRM plan in place from a healthcare professional?’
  • ‘Is the CURRENT problem covered by the firm plan?’

If not, all are answered positively, they are directed into main triage to have any symptoms assessed.

To better understand the reason for calling, additional questions have been added to clarify why contact with a doctor is needed:

  • Callers requiring palliative care where the problem is only about a syringe driver will be advised to ‘Speak to a local service within 1 hour for palliative care’. 
  • Callers with a prescription request and who have been very unwell or worse in the last 24 hours will reach a ‘Speak to a Primary Care Service within 1 hour’ outcome.
  • If the caller has not been very unwell or worse in the last 24 hours, they will be asked what timescale is specified in their plan, and will then reach advise to contact Primary Care depending on their care plan.

Breast problems

Following an NHS 111 Online pilot covering breast lump, breast discharge, nipple and/or breast skin changes, NHS Pathways have made triage enhancements to the breast problem pathways to improve access to direct access breast care clinics.

The following changes were made
  • Adults aged over 30 with a new, painless unilateral breast lump, or aged over 50 with a new, painless unilateral nipple discharge or inversion should be considered for potential breast cancer and will receive a ‘MUST contact own GP Practice within 3 working days’ outcome.

Painless breast lump male and female child differences

Due to an anomaly, NHS Pathways have made changes to the outcomes for male and female children with a breast lump.

Previously, a male child with a painless lump (without fever) would be advised ‘To Contact a Primary Care Service within 24 hours’, whereas a female would be informed ‘For persistent or recurrent symptoms: get in touch with the GP Practice for a Non-Urgent Appointment’.

The following changes were made
  • Both male and female children with a painful breast lump will now be directed ‘To Contact a Primary Care Service within 24 hours’. 
  • In addition, patients with painless symptoms will be advised ‘For persistent or recurrent symptoms: get in touch with the GP Practice for a Non-Urgent Appointment’ and no longer receive questioning of breast appearance.

Dental disposition alignment

Following updated guidance from the Office of the Chief Dental Officer (OCDO), NHS Pathways have made changes that allow certain minor dental conditions to be assessed as a routine dental outcome.

The following changes were made
  • Patients without active dental bleeding and no other high risk symptoms will receive the new outcome, ‘Dental Routine’.
  • This has a 14-day timeframe associated with it to enable identification of an appropriate service.
  • Patients will then need to contact the dental service directly to arrange an appointment.

Pregnancy, bleeding with groin pain acuity

Following feedback, NHS Pathways have made changes to the outcome for patients with abdominal pain and vaginal bleeding.

The following changes were made
  • The question ‘Have you had any abnormal bleeding from the vagina?’ has been added to the ‘Groin Pain or Swelling, Pregnant, Over 20 Weeks’ pathway where there is also associated abdominal pain.
  • If patients answer yes, they will receive a Category 2 ambulance outcome.

Foreign body, penis pathway

Following external feedback, NHS Pathways have rectified an inconsistency identified within the Foreign Body, Penis pathway.

The following changes were made
  • The question ‘Is anything stuck inside or around the penis?’ has been replaced with a similar question with separate answer for 'stuck inside the penis' and 'stuck around the penis'.
  • Patients answering yes to this question will now receive a ‘Refer to Treatment Centre within 1 hour’ outcome.

Repeat prescription

NHS Pathways have continued to review the Repeat Prescription pathways following work completed in a previous release.

To reduce the number of calls reaching a ‘Speak to a Primary Care Service within 2 hours’ outcome, changes have been made to the ‘Repeat Prescription’ and ‘Prescription Request’ pathways.

The following changes were made
  • Additional questions have been added to establish whether the patient currently has any medication available.
  • If medication is available, urgency is now based on when the remaining supply will run out (within 6, 12 or 24 hours).
  • If medication has run out, urgency is based on when the next dose is due. Repeat and controlled medication requests: 2, 6, 12 or 24 hours. Non-repeat medication requests (controlled and non-controlled): 6, 12 or 24 hours.
  • The 2 hour outcome has been removed from all non-repeat prescription requests and will now only remain for requests involving controlled medications where the medication has already run out.

Testicular torsion

A question required updated timescales to align with new Getting it Right First Time (GIRFT) guidelines.

The following changes were made
  • In the testicular torsion triage the onset of pain question has had its timeframe increased from 24 to 48 hours and now reads ‘Did this pain start IN THE LAST 48 HOURS?’

Skin: Acne, spots and pimples

Following feedback from medical expert, patients presenting with blackheads or whiteheads could be redirected to a pharmacy.

The following changes were made
  • Patients over 11 years who have answered yes to blackheads and whiteheads will be asked the following question ‘Have you tried any treatment from the pharmacist?’
  • Patients who answer yes will receive a ‘For persistent or recurrent symptoms: get in touch with the GP Practice for a Non-Urgent Appointment’ outcome. All other patients will receive ‘Contact Pharmacist within 24 hours’.

Last edited: 21 September 2026 4:25 pm