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BMA calls for 'urgent analysis' of NHS 111 but doubts emerge over its figures

The BMA has called for the Government to launch an ‘urgent analysis’ of the impact of NHS 111 on the wider health service, although figures released by the BMA apparently showing a spike in referrals to GPs have been disputed.

It released figures yesterday suggesting there had been a 186% year-on-year increase in referrals to GPs from the telephone triage system, but it later retracted this claim, after the head of communications at NHS England said they had been based on a ‘misreading’ of the data.

But GPC leaders said they are still hearing more examples of patients being referred from NHS 111 with minor ailments, such as colds and sore thumbs, and they said there are ‘serious doubts’ as to whether the ‘huge increase’ in workload is clinically necessary.

The BMA has also said there should be a review of the directions given to patients on self care advice, and the use of medically trained staff in call centres.

The triage service has faced a number of criticisms since its launch in 2013, and the GPC had said it would be unable to cope with demand. The system collapsed soon after launching, with its biggest provider - NHS Direct - eventually having to relinquish its contracts.

It has been singled out for heaping pressure onto GP and A&E services throughout the winter, and Pulse revealed how outages from unexpected demand led to GPs having to step in to offer support over the New Year.

The BMA’s original figures claimed that there were 8,138,863 referrals to GPs from January-October 2014, compared with 2,844,452 in the same period in 2013 - an increase of 186%.

However, it later admitted that this was based on a misreading of the data, and that 5,294,411 calls were passed to GP services between October 2013 and October 2014, compared with 2,844,452 between August 2010 - when pilots started - and October 2013, representing an increase of 86%.

However, as well as comparing two different time periods, this failed to take into account that NHS 111 was only introduced beyond pilot stage in April 2013 and after its immediate collapse, it was up and running in only a few regions in England, only becoming fully national later in the year.

Roger Davidson, NHS England’s head of media, tweeted: ‘Genuinely a shame about the BMA’s 111 story: v demoralising for people to be publicly criticised on basis of a complete misreading of data.’

A spokesperson for NHS England said: ‘What the statistics clearly show is that there is a massive demand from the public for the 111 service.  To date it has coped impressively with this pressure, with the proportion of referrals to GPs and emergency services remaining steady despite the surge in demand. Given this popularity, however, we are continuing to look at ways to make the service even more robust including asking GPs to help support call centres and provide patients with the ability to get high quality medical advice as quickly as possible.’

But another analysis by the Primary Care Foundation – also released today – estimates that there has also been a sharp drop in the percentage of patients given self-care advice, rather than directed to primary care or other interventions, under NHS 111 when compared with its predecessor.

The PCF estimates that 45% of patients were given self- care advice in 2012 under NHS Direct but figures show that in 2013 and 2014 this has dropped to just 15%.

GPC lead on NHS 111 Dr Charlotte Jones said: ‘Anecdotally, GPs have reported to the BMA that patients have been referred to them with colds, sore thumbs or other conditions that could have been treated safely by sensible advice over the phone, advising a patient on how to self-care, such as picking up medication from a local pharmacist. The number of calls logged as “self-care” seems to have dramatically fallen since the introduction of NHS 111.’

She added: ‘There is little doubt that the NHS cannot afford to have unnecessary workload being created given the unprecedented pressure on our health service. GP practices are already struggling to deliver enough appointments to their patients as demand rises, resources fall and staff shortages continue to undermine GP services.’

BMA chair Dr Mark Porter said: ‘We need the government to do a serious and urgent analysis of the effect of NHS 111 on the wider urgent and unscheduled care system to determine where it may be working inefficiently and to ensure that it is cost effective.’

‘This should lead to recommendations on increasing the level of self-care and ensuring that we have a programme to increase the number of expertly trained clinicians answering calls from patients.’

Health secretary Jeremy Hunt has previously suggested that 111 call handlers be given greater powers to use their own ‘judgement’ in calls, which the GPC described as an idea from ‘cloud cuckoo land’.

This article was updated at 9:45 on 4 February 2015.

 

Readers' comments (23)

  • So bring back NHS Direct?

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  • The Government has done the impossible - it has GP cheering for NHS Direct.

    As a slight aside, 111 costs (I think) around £8-9 per call. A GP consultations only costs a little more than that but obviously deals with a lot more (and doesn't generate a further GP appointment for many contacts). It illustrates how a properly funded and resourced primary care service would benefit all sectors of the NHS....

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  • So hold on, you're telling me that an algorithm and an untrained call handler is not just as good at efficiently delivering medical advice as a high achieving professional with 6 years of medical school and a minimum of 5 years postgraduate work and training?

    I just need to pop out and change some powerpoint slides for my presentation 'We don't even need GPs, google is cheaper' for the DOH....

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  • Anecdotally, when I see or hear that a patient has been directed to attend by 111, I expect it is going to be a minor illness, not needing medical input!
    Let's get the stats right so we can back this up.

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  • I blame "the criminal actions" of Hunt and his multi-millionaire cronies.

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  • NHS England are on another planet, and should all lose their jobs for bringing down a system that previously did work - albeit not 100% but managed with the constraints surrounding OOH GP services.
    I worked for our local OOH GP services both on Face to Face and telephone triage (I am an ENP) When NHS111 was introduced, my work colleagues - both doctors and nurses - recognised that this would never work long term due to the program being decision making and NOT decision support software. Last year in March I was made redundant, together with my colleagues! Not once were any medical staff working 'at the coal face' asked their opinion of this new system. After redundancy, I wrote to the DOH and my MP. Lord Howe wrote back, suggesting this be taken up with NHSE who initially tried to fob me off. I asked specific questions regarding the management of NHSD, NHSE, financial accountability etc. but being at the bottom of the pecking order never really got anywhere. I've moved on, got alternative employment outside of the NHS - and now I sit and laugh at the cock-ups and excuses made for an OOH system that is absolutely useless, AND how NHSE manages to survive when it is run by a bunch of twits who lie continuously.
    GP's - I salute you and wish you luck in an impossible situation.

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  • "Roger Davidson, NHS England’s head of media, tweeted: ‘Genuinely a shame about the BMA’s 111 story: v demoralising for people to be publicly criticised on basis of a complete misreading of data."

    What, like the CQC risk ratings did, but I don't recall you criticising the CQC.

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  • The whole sorry affair is a direct result of failure to invest in an expansion of primary care. The 2004 contract recognised that the whole system was under duress and gave us big pay raises to shut up. This gesture was not accompanied by any forward planning, but did result in many alternative, very expensive initiatives ( community matrons, NHS direct, walk in centres, increased numbers of paramedics, increased role for pharmacists etc) each of which was incapable of meeting the objective of getting it right first time. The net result has been the creation of a tidal wave of unsatisfied need with an escalation of the concept of urgent as being something NHS111 cannot deal with right now: Semi skilled people making semi skilled decisions leading to grave errors each of which adds burden to an overheated system. There is no short term answer, as there is no spare capacity in the system. Long term solutions include a massive expansion of primary care paid for by getting rid of the very costly alternatives which have been put in place in order to avoid making such an investment.

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  • Vinci Ho

    As I always say, identify correctly who is our enemy?In a system like this , you always have a competition of where money should go . Bottom line is you need colleagues(doctors and nurses) with the right experiences to stand at the frontline and they are to be rewarded. The government ? It just wants cheaper the better. That is why it comes up with all sorts of nonsense. NHS111 is a 'classics' in the history of how this government has been running the NHS. For those who does not like this comment, go home and look at your mirror, still recognise your reflection ,eh?

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  • Dear Paula - sounds like the NHS has lost another good worker. Good luck to you I hope I can get the courage (or mortgage paid off) to exit too. (GP of 18 years)

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  • Before any new service is rolled out nationally - a good few pilots would have been done. I wonder who analysed the outcomes of those pilot studies relating to 111 before it was meant to become a national pandemic.

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  • 111 utter waste of public funds.
    Not Cost effective cost 9pounds /call which is shade below GP cost. However, when you take into account of unit time spent by 111 caller-> cost probably doubles!
    They work on basis book all the ooh base slots and when full- buck is passed to GPs to telephone triage. Not invariably needs F2F but no capacity at Base for this. The GPs are risk averse and request patient to come to base- in doing so the base slot are double or triple booked. This raise issue of safety.

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  • At the risk of incurring the wrath of many, I remember this same discussion when NHSD was first launched ie a belief ( whether backed by figures or not) that it generated more work for primary care. The same case was also made that GP's with their training and expertise are always going to be better than others at identifying and managing clinical risk.
    With capacity pressures on GP's nationally and no quick fix to recruiting more the answer is unlikely to be found in creating more GP roles in NHS111.
    What it does suggest to me though is an urgent need to GP's as commissioners to exert more influence within their local service. When was the last time your membership group or Governing Body assured NHS111 or the directory of services was reviewed?

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  • Are all the people interpreting the 111 figures using the same figures?
    Could Pulse (or NHS England or the BMA or the Primary Care Foundation) provide a link to the raw data, so that we can try to see for ourselves what the data actually is?
    For instance, is there a difference between different areas? (111 - unlike NHS Direct) is a *local* service) and if so, is there anything to be learned from the differences (e.g. involvement of ShropDoc)?
    Regardless of when 111 started in each area, is there an increase in numbers of calls, and/or numbers & percentages referred to GPs, A&E and ambulances over the arrangements in each area in the preceeding year/time period?
    One of the graphs I have seen of A&E attendances (showing an increase in 2014 over 2013) seems to show a sudden and sustained increase from December/January 2013: *is* there any relation to 111 calls?

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  • See GP, 111 booking an appointment for GP to see for sore throat and sore toe because of tight shoes at 04.00 am, is slightly better. 111 send call to OOH doctors services to visit to change colostomy bag, to help change night pad because it is soaked is a disgrace for the system. An ambulance sent to a patient for sore throat but chest tightness with a classical MI booked as base appointment. Can the call handlers at 111 be taken to GMC?

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  • Because of 111, OOH service has become an in hour service and suffers with lack of capacity hugely in all areas of the country. Patients with abscess, cuts and wounds come to OOH, it becomes the doctor's sin to tell the patient that in OOH we do not suture and do not do incision and drainage because somebody great in 111 has booked an appointment.

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  • Can BMA also look into how many useless ambulance calls are made by 111? Each ambulance call costs if I am right about £ 500 to £ 700. What a waste of funds. In addition to collecting figures, our BMA should speak to frontline NHS staff working in OOH.

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  • "A spokesperson for NHS England said: ‘What the statistics clearly show is that there is a massive demand from the public for the 111 service"
    So we art treating demand & wants now - not need - that's where we are going wrong, that's why we are so busy!!

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  • "the proportion of referrals to GPs and emergency services remaining steady despite the surge in demand"
    Doesn't this mean that if the number of calls doubles the number of onward referrals doubles. so if this was extrapolated and we all called, the same %age would be referred to other services - whether there was a need or not?

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  • "Health secretary Jeremy Hunt has previously suggested that 111 call handlers be given greater powers to use their own ‘judgement’ in calls,"
    Go to A&E
    Sorry for getting so Het up reading this apology for the bu!!$h!£ service.

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  • Vinci Ho

    We have now sunk to a depth at which the restatement of the obvious is the first duty of intelligent men.

    George Orwell

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  • 111 was a joke from the outset - not only recognised by us as OOH GP's but more significantly by the users themselves frequently apologising for wasting resources and delaying help for those truly in need when brought to the centres via ambulance; all courtesy of 111. Everyone knows it's been a huge waste of money.

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  • ultimately it's all a fault of the 'disastrous' 2004 contract - you remember that when GPs' were responsible for 24 hr 265 care. prior to that everything was 'great' in GP land - there was much dancing and merriment. I joined as part of the 2004 intake and was offered a golden hello something to do about a 'recruitment crisis'. I was encouraged to 'trust' our leaders. Fast forward to now and history repeats itself - sorry but i'm all out of trust. Whatever they offer - don't do it.

    The future is in insurance backed small independent GP owned / managed / staffed practices or servitude.

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