NHS Pathways system update - clinical release note - release 49.2.0

Release 49.2.0 was made available to suppliers and providers on 22 September 2025.

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 49.2.0 are highlighted below. Release 49.2.0 was made available to suppliers and providers on 22 September 2025.

What we've changed

NHS Pathways have refined the triage process for identifying potential ectopic pregnancies as part of the ongoing review of Category 3 outcomes.

Faint or blacked out question for Ectopic Pregnancy Category 3

In the abdominal pain and associated symptomatic pathways, the ectopic pregnancy related questions asking if a patient has blacked out or felt faint will now only be asked to females aged 12-55 who are pregnant or are ‘not sure’ if they are pregnant.

Following stakeholder feedback, NHS Pathways have made changes to how the system triages a suspected asthma attack in the non-trauma emergency pathways.

Update to Asthma triage

Adults and children over the age of 5 with the following symptoms will now receive a Category 1 Ambulance outcome: Have declared asthma, are fighting for breath and are confused/agitated/drowsy, OR have declared asthma, are fighting for breath and are a deathly colour
Prior to Release 49, a Category 1 outcome required declared asthma, drowsiness AND deathly colour.

Following liaison with dental experts, NHS Pathways have made changes to the triage of dental problems.

Dental review

For patients with toothache (without a dental injury or dental bleeding) the question to identify extensive facial swelling has been amended to ‘Are you unable to open an eye because of swelling?’.
Care advice about re-implanting and storing an avulsed tooth has changed. References to saline have been removed where appropriate and the instruction to place the root of the tooth in the patient’s own saliva has been added.
Patients who are immunocompromised are now provided with advice to re-implant an avulsed tooth immediately if possible.

As part of a wider Primary Care review NHS Pathways made changes to the Assessment of Required Level of Response pathways.

Primary Care Service Selection

NHS Pathways have reversed the order of the timeframes (for timeframes less than or equal to 24hrs) for the below services, placing the longest timeframe at the top and the shortest at the bottom in the Assessment of Required Level of Response pathways: Contact a Primary Care Service Speak to a Primary Care Service Speak to a Palliative Care Service
This change has only been made to pathways used exclusively by clinicians and has been done to reduce instances where the shortest timeframe is chosen because it appears first.

To ensure consistency with NHS.UK, NHS Pathways made changes to the altered bowel problem questions.

Horizon scanning evidence for Gynaecology symptoms

Questions that previously asked if symptoms had lasted for 6 weeks have now been changed to 3 weeks as follows:
Have you had the symptoms for MORE THAN 3 WEEKS?
Have you had a change in bowel habit for MORE THAN 3 WEEKS?

Continuing work completed in R47.2.0, NHS Pathways were required to make refinements to the triage process for the use of spare Adrenaline Auto-Injectors (AAIs)

Enhancements to Adrenaline Auto Injectors (AAI) use criteria for adults in school settings

One additional specific symptom presentation has been included to increase the opportunity of using a ‘spare’ adrenaline auto injector (AAI) within a school setting for adults:
Unconscious adults with a history of previous severe allergic reaction without noisy breathing can now reach advice regarding the use of a school’s ‘spare’ AAI in the same way those with noisy breathing can. Children are unaffected as they will have already reached this advice.

Further to work completed in R46 to change some of the ‘not sure’ routing for septicaemic rash, NHS Pathways have made the following changes.

Unexplained Bruising Amendment to the ‘not sure’ answers

If a patient being triaged for unexplained bruising answers “not sure” to the question ‘Have you developed one or more new marks, like bruising or bleeding under the skin?’, this will now be treated the same as answering ‘no’. This aligns with how a suspected septicaemic rash is triaged elsewhere in the system (excluding those within the allergic reaction and skin rash pathways).

Following stakeholder feedback, NHS Pathways have made changes within some of the Sore Throat pathways to improve clarity and clinical relevance as part of a staged approach to the refinement of the pathways.

Update to the assessment of sore throat symptoms

The question ‘Have you got lots of blisters or ulcers inside the mouth?’ will no longer be asked during triage for adults and children whose main symptom is a sore throat and hoarse voice, and toddlers with a sore throat (where relevant). Other existing questions will remain to identify serious illness where appropriate.

To ensure consistency across the system, NHS Pathways have made changes to the outcome reached for adults over 65 years of age with potential cancer symptoms.

Potential cancer symptoms

Adults over 65 years of age with a cough but who are not coughing up blood (no haemoptysis) and with constitutional symptoms that could suggest potential cancer symptoms will now be able to: Reach a ‘MUST contact own GP Practice within 3 working days’ outcome. Receive a ‘PC potential cancer symptoms' discriminator. This is to support how cases can be managed for their onward care

Last edited: 22 September 2025 4:50 pm