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Gulf in 111 out-of-hours impact revealed

Pilots of the NHS's 111 urgent care number have pushed up out-of-hours attendance in some areas and seen it plummet in others - laying bare the dramatic variation in the service's impact on GPs.

The Department of Health's 'system impact' data, which covers the period up to August, show that GP out-of-hours consultations in Lincolnshire - one of four national pilot areas - went up by 7%. A separate pilot in County Durham saw a 6% rise in GP out-of-hours consultations, urgent care attendances and walk-in centre attendances.

But the Luton pilot saw a 13% drop in out-of-hours consultations with GPs.

The data exposes disparaties in A&E attendances between the four pilots, with Nottingham City witnessing a 19% rise in A&E activity comparde with a 1% drop in County Durham.

The findings come as out-of-hours providers warned that the NHS 111 software would add to the workload of out-of-hours providers.

Dr David Lloyd, a GP in Harrow and medical director of Harmoni, the country's biggest out-of-hours provider, said: ‘The way the software works is that the disposition is to send people who call to primary care and if that is at a time when the GP surgery is shut that them means going to an out of hours service, so it is inevitable there will be an increase.'

‘This shows the need for integration. If you have a company running the 111 service and the OOH service then you are able to co-ordinate and integrate properly. If it is one person running the phone system and another the OOH service then there is a risk that you will get overload of the latter.' 

In total, across the four pilot sites, a third of callers were referred to primary care.

Rick Stern, urgent care lead for the NHS Alliance, which represents around two-thirds of out-of-hours providers, said: 'It is early days for NHS 111, but our concern is that there is likely to be more activity for out-of-hours providers at a time when we are trying to control activity.'

'NHS Pathways is a non-clinical assessment, so it has to build in extra patient safety, which is likely to to generate more face-to-face contact with clinicians and home visits.'

The news comes as LMC leaders warned that there was a risk that hospitals could take over the new 111 franchises to the detriment of primary care.

Dr Kambiz Boomla, a GP in Tower Hamlets, East London, and chair of City and Hackney LMC, said: ‘The guidelines and the running of this service has to be very strongly influenced by GPs to bring in all the principles of correct demand management to ensure people do follow the correct pathways.'

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