Failure to reliably telephone patients when follow-up or assessment requires it
First to latest report 24 Mar 2014 — 12 Aug 2024
Reports that mention this concern
18
Times this concern has been raised
18
Stated actions linked to this concern
23
What this concern includes
Includes failures to make required telephone contact with patients or their families for patient follow-up, requested contact, or assessment of a requested service.
What is not included
Excludes failures to telephone treating healthcare professionals about abnormal results, unless the concern is specifically patient or family telephone follow-up or assessment.
Excludes general failures of referral escalation, investigation tracking, or safety-netting that do not specifically involve required telephone contact.
Excludes isolated communication failures unrelated to a required patient or family telephone contact.
Trends
Reports over time
Reports mentioning this concern, over time
Reports about this concern issued each year.
* 2026 is projected from reports observed to 7 Sep 2026.
Most frequent recipients
Most frequent recipients
Reports about this concern sent to each recipient.
Department of Health and Social Care3
Welsh Ambulance Services NHS Trust3
South East Coast Ambulance Service NHS Foundation Trust2
Welsh Government2
Aneurin Bevan University LHB1
Cardiff & Vale University LHB1
Central and North West London NHS Foundation Trust1
Daughter of the deceased1
Frimley Health NHS Foundation Trust1
Healthcare Inspectorate Wales1
Hereford Medical Group1
Kent and Medway Mental Health NHS Trust1
King's College Hospital1
London Ambulance Service NHS Trust1
NHS England1
NHS trust14
Healthcare site4
Ministerial department3
Devolved government2
Local health board2
Clinical commissioning group1
Coronial office1
Executive non-departmental public body1
Health and care inspectorate1
Health professional body1
Independent healthcare provider1
Integrated care board1
Type not available1
Reports and published responses 18 reports
See individual reports that have raised this concern, and the actions taken in response
Manchester North
Concerns raised1
Failure to make a 48-hour post-discharge follow-up call
This report raised 13 other concerns. They are not shown here because they do not form part of this recurring concern.
Linked response
Priory Group
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
Priory Group
A 48-hour follow-up call is not required where a confirmed NHS community appointment exists within 72 hours of discharge.
Existing arrangements considered sufficientThe respondent said that existing arrangements were sufficient, so no further action was needed.
Inner West London
Concerns raised1
Failure to provide follow-up contact or assessment after an interrupted treatment call
This report raised 4 other concerns. They are not shown here because they do not form part of this recurring concern.
Linked responses
Central and North West London NHS Foundation Trust
NHS England
Stated actions An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.2
Central and North West London NHS Foundation Trust
Review guidance on follow-up after treatment sessions are interrupted and calls are disconnected.
Central and North West London NHS Foundation Trust
Clarify for staff the actions required after treatment sessions are interrupted and calls are disconnected.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.2
NHS England
Responding to the Coroner’s specific concerns falls outside NHS England’s remit.
Outside remitThe respondent said that this matter was outside its role or authority.
NHS England
The Trust is responsible for responding to the Coroner’s specific concerns.
Redirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
Sefton, St Helens and Knowsley
Concerns raised1
Failure to follow up whether a patient has obtained urgent medical assistance
This report raised 6 other concerns. They are not shown here because they do not form part of this recurring concern.
No linked response statements
No respondent-stated action or position is linked to these concerns in the published data.
Herefordshire
Concerns raised1
Failure to telephone patients as requested or advised
This report raised 4 other concerns. They are not shown here because they do not form part of this recurring concern.
Linked response
Hereford Medical Group
Stated actions An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.1
Hereford Medical Group
Update reception protocols so receptionists telephone patients first to explain the GP’s triage decision.
Inner West London
Concerns raised1
Failure to contact the patient after discharge
This report raised 2 other concerns. They are not shown here because they do not form part of this recurring concern.
Linked response
Priory Group
Stated actions An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.2
Priory Group
Remind nursing and medical colleagues to telephone patients 48 hours after discharge, unless qualifying community or crisis-team follow-up is confirmed within 72 hours.
Priory Group
Continue monthly audits of post-discharge telephone calls until three successive months achieve 100% compliance.
Mid Kent and Medway
Concerns raised1
Failure to conduct an adequate location-finding follow-up call
This report raised 3 other concerns. They are not shown here because they do not form part of this recurring concern.
Linked response
South East Coast Ambulance Service NHS Foundation Trust
Stated actions An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.1
South East Coast Ambulance Service NHS Foundation Trust
Implement a patient-location verification process requiring team-leader escalation, call review, records checks, contact with information sources, and local hospital and police checks.
Gwent
Concerns raised1
Failure to make contact with callers or their families
This report raised 5 other concerns. They are not shown here because they do not form part of this recurring concern.
Linked response
Welsh Ambulance Services NHS Trust
Stated actions An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.1
Welsh Ambulance Services NHS Trust
Review policies and procedures for establishing contact with patients or callers at scene.
Surrey
Concerns raised1
Failure to maintain scheduled telephone contact with discharged patients or their families
This report raised 5 other concerns. They are not shown here because they do not form part of this recurring concern.
No linked response statements
No respondent-stated action or position is linked to these concerns in the published data.
South Wales Central
Concerns raised1
Delays in making and chasing-up welfare calls
This report raised 5 other concerns. They are not shown here because they do not form part of this recurring concern.
Linked responses
Cardiff & Vale University LHB
Welsh Ambulance Services NHS Trust
Stated actions An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.1
Cardiff & Vale University LHB and Welsh Ambulance Services NHS Trust
Remind clinical contact centre leads to handle Protocol 23 overdose cases promptly.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
Cardiff & Vale University LHB and Welsh Ambulance Services NHS Trust
Demand-related capacity constraints make it challenging to undertake a robust welfare-call procedure consistently.
Unable to actThe respondent said that a constraint prevented them from taking the relevant action.
Inner West London
Concerns raised1
Failure to return calls within pre-set time guidelines to obtain further medical details
This report raised 1 other concern. They are not shown here because they do not form part of this recurring concern.
Linked response
London Ambulance Service NHS Trust
Stated actions An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.8
London Ambulance Service NHS Trust
Deliver refresher training for Control Services staff on call handling and MPDS application, including an anonymised learning-from-experience case study.
London Ambulance Service NHS Trust
Reassess minimum Clinical Hub staffing levels in light of the new national response standard and increased demand.
London Ambulance Service NHS Trust
Secure funding for additional recruitment to address Clinical Hub and operational staffing pressures.
London Ambulance Service NHS Trust
Introduce three additional Clinical Hubs in Kenton, Barking and Croydon to increase flexible Clinical Hub staffing capacity.
London Ambulance Service NHS Trust
Introduce a further Clinical Hub in New Malden to expand local Clinical Hub coverage.
London Ambulance Service NHS Trust
Run a specific Clinical Hub recruitment programme to increase the pool of staff trained in Manchester Triage System and Clinical Hub procedures.
London Ambulance Service NHS Trust
Continue the operational staff recruitment drive to increase available staffing capacity.
London Ambulance Service NHS Trust
Submit LAS data to the national review of ambulance response priorities, call-backs and safe systems to support improvement and learning.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
London Ambulance Service NHS Trust
The national review of ambulance response times and safe call-back systems is led by the Association of Ambulance Chief Executives.
Redirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
Actions and positions describe what organisations say in published responses. Implementation is not independently verified.
Actions and positions describe what organisations say in published responses. Implementation is not independently verified.