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Crisis of confidence in NHS 111 as only 8% of GPs think triage is 'safe for patients'

Exclusive GPs have lost confidence in the ability of the NHS 111 service to triage patients, with only 8% saying they believe the urgent care phoneline is safe for patients.

In a major blow to the service, 71% of the 440 GPs surveyed by Pulse said that they did not have confidence that the triage at NHS 111 call centres was safe for patients.

The survey also found that confidence was little better among the 291 GPs in areas where NHS 111 has been rolled out, with only 12% saying they were confident the triage was safe for patients. Some 70% disagreed with the statement.

More than half of those in areas where the troubled service has been rolled out say that they have experienced a high workload since the helpline had been rolled out, mainly citing the long reports sent to practices after their patients call the phone line.

This survey comes as Pulse revealed last month that NHS England is considering a change to the triage process to include more clinically trained call handlers.

The computerised algorithm used by NHS 111 is operated by non-medically trained call handlers - with some clinical input if the caller doesn’t accept the call handler’s recommendation, or they have complex medical needs. But the phone line has been plagued with problems, and Pulse revealed in May that there had been 22 serious untoward incidents involving NHS 111 in the first six weeks of its soft launch.   

Many of the GPs surveyed said that the lack of medically qualified call handlers was their main concern with the phone line.

Dr Andrew Mimnagh, the urgent care and 111 implementation lead for South Sefton CCG, said: ‘It is deeply regrettable that the profession has a low level of confidence in this system of triage.

‘It is [also] deeply regrettable that the incident data reporting is so deficient, that I cannot disabuse them of that view.

‘It is a fact that our local clinical assurance group has had to put on the risk register that we cannot assure the safety of the 111 service in this region.’

Dr Bob Hodges, a GP in Gloucester, said: ‘It is a flawed concept and utterly nonsensical - triage by computer is dangerous and shifts and magnifies costs and risk for no benefit.’

Another GP said: ‘Only a third of calls made it through to the out-of-hours services in the first months. The average wait for 111 to pick up was 40 minutes. Workload for out-of-hours services is now more like normal so it is improving. They are still sending 999 ambulances for ridiculous problems, for example a heavy period.’

Another doctor commented: ‘Just reading their ridiculous communications makes my head throb.’

But NHS England defended the service, saying call handlers were ‘fully trained’.

A spokesperson said: ‘They use a clinical assessment system which enables them to assess a caller’s needs safely and effectively and direct them to the right local NHS service. All advice provided is supported by experienced nurses.

‘Using the clinical assessment system means a smaller proportion of calls need to be referred to a nurse. This means that NHS 111 nurses can focus on cases where their clinical skills are most needed rather than dealing with calls that don’t need their expertise. However, should a patient be assessed as needing to speak to a nurse, they will be put straight through to a nurse.’

What GPs think of NHS 111


Do you have confidence that the triage at NHS 111 call centres is safe for patients (total GPs)?

Yes - 8%

No - 71%

Don’t know - 20%


Do you have confidence that the triage at NHS 111 call centres is safe for patients (GPs in areas where NHS 111 has been rolled out)?

Yes - 12%

No - 70%

Don’t know - 18%

Have you noticed an increase in workload since the introduction of the NHS 111 service (GPs in areas where NHS 111 has been rolled out)?

Yes - 53%

No - 33%

Don’t know - 13%


Source: Pulse survey of 440 GPs


Readers' comments (14)

  • If every part of the nhs system worked effectively we wouldn't need 111... also if patient education/self care advice was better we wouldn't need 111

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  • my last comment on the subject.... oohs in any form should be for the patients interests and not the provider/contractor doing it. (wise words of husbands).

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  • "But NHS England defended the service, saying call handlers were ‘fully trained’."

    To do what exactly?!? Peel a banana?!?

    As a - previously dedicated - OOH GP I experience the crap coming from NHS 1mbec1l1c on a nightly basis: If it wasn't so scary, it would be funny: "Thigh pain", algorithm used: Abdominal pain. Patient's wife: "He's got pain in his ribs." Or, just last night, a (British) surname misspelt beyond recognition. And it's "Ernest", not "Eurnest"! That's just the basics.

    Add to that 999 ambulances being dispatched through Pr1m1t1ve to patients with - presumably life-threatening - sinusitis and one loses the will to live.

    The concept is fundamentally flawed, the implementation is shambolic - greetings, South East Coast Ambulance Service!!! - and the people responsible should get the 'Clarkson treatment for striking public sector workers'!!! (Question is: Do we start with Dr Peter Fox or do we leave him till last?).

    Failing that, they should be struck off for their participation in a 'system' that is detrimental to patient care.

    [This comment has been moderated by the author.]

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  • Another example of ministerial cock up! The overpaid and incompetent ministry officials and bureaucratic non-medical and self-serving consultants that put forward the triage system failed to consider the unwanted consequences of using medically unqualified advisers at the end of the phone line. When will any government ever make these ministerial wooden pegs fully accountable for their expensive cock ups?

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