The 111 concept is fatally flawed, NHSD has never got through a winter without their systems collapsing at times of peak demand. Up to now GP OOH services have been able to flex their resources in responses to levels of demand up to 3 times normal, usually during the winter flu season and bank holidays. Not only is the Pathways system less efficient at managing demand, the onerous training needed means that no provider will be able to train, and keep trained, enough staff to cover peak times. But once 111 is rolled ot there will be no more OOH call centres to cope when the big call centres are flooded. Heaven help the ambulance and ED services.