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Climbdown over NHS Direct deadline

The Government has been forced to put back by two years its highly-publicised 2004 deadline for NHS Direct to act as the first point of contact for all out-of-hours calls.

In a humiliating indication that NHS Direct cannot cope with the workload, the Department of Health said the nurse-led helpline would not be ready to integrate with all GP out-of-hours providers until the end of 2006.

But all co-operatives will be expected to set up phone links with NHS Direct by the end of next year.

A three-year strategy document on NHS Direct, published last week, also revealed plans to fast-track any caller likely to need a face-to-face GP consultation for triage by a co-op or deputising service. Protocols will define symptoms that should trigger fast-tracking and the system is being piloted in Sheffield and Bedford.

The document said NHS Direct's capacity would double by 2005/6. The helpline will be expected to take on all low-priority 999 calls.

But co-ops said the service would need to quadruple in size to cope with all out-of-hours calls across England and Wales.

Funding will be devolved from Whitehall to PCTs from 2004, with trusts taking on a commissioning role and setting the pace of integration.

Dr Fay Wilson, medical director of Birmingham and District GP Emergency Rooms and a GP in Birmingham, said: 'NHS Direct is going to become more efficient by fast-tracking calls to GPs ­ are they fast-tracking some of the resources as well? How can it fail? When it does not meet the target it gets a new target and new funding?'

Dr David Lloyd, external relations director of west London co-op Harmoni and a GP in Harrow, Middlesex, said delaying the deadline for integration to 2006 was realistic.

He welcomed moves for closer joint working between NHS Direct and PCTs, but added: 'PCTs are paying for it but it's a national organisation, so there could be some tension.'

Dr Mark Davies told emergency care tsar Professor Sir George Alberti that successful integration of NHS Direct with GP co-ops hinges on call handling rather than nurse triage.

Sir George visited Yorkshire Pennine doctors on-call last week to find out GPs' experiences since it became the first co-op to integrate with NHS Direct four years ago.

Dr Davies, co-op medical director and a GP in Halifax, said NHS Direct dealt with half of all calls without involving GPs. He added: 'The vast majority of that 50 per cent are filtered out by call-handlers ­ people ringing for appointments or prescriptions.'

Call handling key to success, says first co-op in link-up


three-year strategy

for NHS Direct

 · Deadline for NHS Direct to act as first point of contact for all out-of-hours calls put back two years to 2006

 · Funding: £105 million in 2003/4, rising to £182 million in 2005/6

 · Capacity: to rise from six to 16 million calls a year by 2006

 · Protocols will set out symptoms likely to require face-to-face consultation; they

will be fast-tracked to out-of-hours GPs

 · PCTs to take on commissioning role and set pace of integration and local priorities

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