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GPs must take the lead if NHS 111 is to succeed

GPs are key to out of hours care, Dr Brian Gaffney writes - after all, this is a service for primary care and patients, so who is better placed to implement it?

Your urgent care system is undergoing a radical change - it's called NHS 111 and it will shortly be arriving at a telephone near you.  

Every GP knows about the surge in demand for unscheduled care, 999, A&E and out of hours services. What we are about to see is the introduction of a new access point for patients which is free to call, will assess patients' needs and direct them to the most appropriate and effective point of care. By the way, it is also meant to help manage demand and make the whole urgent care system more effective.

It's quite clear to me, looking at the emerging findings from the pilots, that NHS 111 is not yet fully developed or understood, but that isn't stopping procurement processes going ahead at full steam.

NHS 111 will only work if it is fully integrated into existing urgent care systems, and this will only happen if GPs take a lead on their local NHS 111 service immediately. Dare I remind you of the last time a telephone triage service was introduced into primary care without GPs' full support?

If you are a GP who questions the very existence of NHS Direct's telephone service, you need to grab the chance to lead the development of its replacement, not least because Clinical Commissioning Groups (CCGs) will inherit NHS 111 contracts and be responsible for the service in their local area.

Whether GPs like it or not, there is much to be learnt from NHS Direct. Patients and their families (nearly five million of whom call NHS Direct every year, not to mention the 10 million who use the online symptom checkers) really appreciate the service and follow its advice. We know that by delivering a high quality clinically-led service, 50-60% of patients receive self-care advice and do not require onward referral.  

To get these results from NHS 111, the service needs careful, clinically-led commissioningand procurement. GPs also need to understand the impact that the new service is likely to have on their wider urgent care systems. NHS 111 has been designed to be very different from NHS Direct, and we know from our pilots that NHS 111 supports fewer patients to self-care than the 0845 4647 service, and refers more to face-to-face urgent care services.

The introduction and development of NHS Direct provides us with some important lessons. Over the last 12 years, NHS Direct has responded to a wider change in how patients want to access healthcare and health advice. We know that more people now access our services on the web and mobile app than they do over the phone; this is in part is because patients expect health advice and information to be available quickly and conveniently to suit busy lifestyles - on the move, away from home. 

Patients still greatly value health advice from their GPs but they will readily go elsewhere. For GPs to have the biggest influence, they need to take a step back and think about how they have managed change in the past. The change in how patients access healthcare has never been fully embraced by primary care services. In general access to GPs has followed a traditional pattern and in many cases others have been left to fill the vacuum and run parallel primary care services that lack integration. We don't want to see history repeating itself with NHS 111.

It is essential that GPs take the time to understand the NHS 111 service, assess the impact it is likely to have on their local urgent care system and lead local commissioning and procurement. Localities are choosing to take different approaches in the way they are implementing NHS 111 in their areas, but whatever they are doing GPs need to be in the driving seat.

This is a prime opportunity for GPs to take a proactive, leadership approach to ensure NHS 111 is integrated into primary care and contributes to a significant advancement in urgent care. This will provide the most effective care for their patients rather than sending them to packed surgery waiting rooms or overflowing A&E departments.

Dr Brian Gaffney is a medical director of NHS Direct

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