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NHS Pathways system update - clinical release note - release 52.2.0

Release 52.2.0 was made available to suppliers and providers on 29 June 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 52.2.0 are highlighted below. Release 52.2.0 was made available to suppliers and providers on 29 June 2026.

What we've changed

Dental Commissioning Standards outcome changes

Following a mandate from the new Dental Commissioning Standards (2025), NHS Pathways have updated the dental outcomes within triage to align with the new Dental Commissioning Standards.

The updated outcomes will be
  • Dental emergency 60 mins
  • Dental Unscheduled Urgent 24 hr
  • Dental Unscheduled Non-Urgent 7 days

Nail avulsion

Following a review by the National Clinical Advisory Group (NCAG) of the Limb Injury pathways, NHS Pathways reviewed all pathways where nail avulsion is assessed.

The following changes were made
  • For both adults and children, when a nail avulsion is identified, a new question ‘Did the nail injury occur within the last 24 hours?’ has been added. This will enhance the identification of those needing urgent or non-urgent referral to an Emergency Treatment Centre.

Skin lumps

NHS Pathways have reviewed the Skin Lumps pathways for patients of all ages.

The following changes have been made
  • The outcomes were safely amended to less urgent primary care outcomes to support demand in primary care.  This applied to those with a lump that is not painful without a temperature and has been there for less than 2 weeks. This will support demand within primary care.

Skin lumps

Following feedback from the National Clinical Advisory Group (NCAG), changes have been made to the Skin Lumps pathways.

The following changes were made
  • Patients with a lump that is not on the head or neck, and no high temperature and already seen a doctor will no longer be asked ‘Is the enquiry about having the lump removed?’ and will be safely referred for home management rather than seeking a GP appointment.  

Needle-free adrenaline spray

Following a new needle-free adrenaline nasal spray receiving Medicines and Healthcare products Regulatory Agency (MHRA) approval, NHS Pathways have made changes to questions that reference injection.

The following changes have been made
  • In questions where the wording referenced ‘adrenaline injection’, this has been updated to ‘adrenaline injection or adrenaline nasal spray’ or simplified to ‘adrenaline’ where appropriate.

Rectal pain, swelling, lump or itch

NHS Pathways have continued to review the Rectal Pain, Swelling, Lump or Itch pathway in line with current National Institute for Clinical Excellence (NICE) Cancer guidelines.

The following changes have been made
  • To improve referral of patients over 40 with a change in bowel habit will be asked if there is rectal bleeding and if so, will reach an outcome of must contact own GP Practice within 3 working days, for potential cancer symptoms. 

Last edited: 29 June 2026 3:30 pm