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Delays, abandoned calls and an 11-hour wait for a call-back: Leaked document reveals the extent of NHS 111 performance issues

Exclusive: Patients in 30 different areas of the country waited in some cases for more than an hour for a call-back from NHS 111 over the Easter period, according to an internal NHS document which highlights problems affecting the troubled new urgent care service.

The NHS 111 Easter SitRep report, obtained by Pulse, provides day-by-day performance data from every area in England. It shows more than 40% of calls to NHS 111 were abandoned by patients in some regions, while elsewhere one patient waited more than 11 hours for a call-back.

Although a series of alarming anecdotal complaints have emerged in recent days, the document reveals for the first time the true national picture – and comes despite NHS England insisting immediately after Easter that ‘many areas in England already have an excellent responsive NHS 111 service’.

In total 17 of the 37 areas to have deployed NHS 111 by the end of March failed to answer calls from some patients within 10 minutes, while on Good Friday at least one in five calls were abandoned in 14 different areas.

Some 30 areas reported that the longest time taken to call a patient back was more than an hour. Although the data does not specify the type of call, the NHS 111 service specification states that where a clinical assessment is required, calls should be transferred ‘without the need for a call back’, and ‘in exceptional circumstances where a nurse is not available, the caller should be called back by a nurse within 10 minutes’.

Pulse has learnt NHS England has now introduced a new layer of approval to further launches of the triage service, with a committee appointed to sign off any further rollout in the 23 areas where NHS 111 is not fully live.

The NHS 111 report, produced by NHS England for local managers, summarises the performance of all NHS 111 providers across England from 26 March to 1 April.

It shows in the area formerly covered by Kent, Surrey and Sussex PCT cluster, one patient waited 11 hours 29 minutes for a call-back. On 29 March 43% of calls lasting longer than 30 seconds were abandoned by the patient before they were answered in the area covered by NHS Gloucestershire and Swindon cluster; on 30 March in the area covered by NHS Dorset the figure was 44%.

A spokesperson for South East Coast Ambulance Service NHS Foundation Trust, which provides the service in Kent, Surrey and Sussex, was unable to comment on specific cases but said demand from patients at the weekend was ‘higher than anticipated’ and apologised to ‘callers who are waiting longer than we would like’.

A spokesperson for Harmoni, which runs the service in Gloucestershire and Swindon, said: ‘The start of this service in the South West, as in other parts of the country, has created some areas where we have yet to achieve the high levels of service we will meet over time. We are working with commissioners, the ambulance trust and other providers to address these issues.’

Meanwhile NHS Yorkshire & Humber and NHS Dorset both reported the longest recorded wait for an answer to a patient’s initial call was more than 30 minutes.

A spokesperson for South Western Ambulance Service NHS Foundation Trust, which provides the service in Dorset, said: ‘The extremely high numbers of people calling the 111 service over the Easter weekend undoubtedly presented challenges and we are aware that we were not able to provide the level of service that we would want or expect to many of our patients, for which we are sorry.’

A Yorkshire Ambulance Service spokesperson said: ‘For a new service NHS 111 is performing well and we will continue to work with our healthcare partners to develop the service as further rollout continues across the region.’

Dr Richard Vautrey, deputy chair of the GPC, said the extent of the problems nationally were a real concern: ‘The key is that NHS England needs to be open and honest about the situation. They can’t keep saying these are teething problems.’

‘There is a potential of danger for patients, waiting for so long that they are being put at risk. That is unacceptable.’

‘They also need to increase the capacity of the call handlers to cope with the volume of calls. They need more clinicians involved in advising the patients.’

Dr Stewart Kay, a GPC member and GP in south London, said: ‘If these were old style out-of-hours providers performing like that, they would have had their contracts cancelled in days. There’s a whole new set of rules for these providers than there were for the previous providers.’

‘It is a complete dog’s breakfast. The local managers, even the senior ones, are as unhappy about this as everyone else. This was an imposition and I am sure they have all been told they have to follow the party line and say it is going splendidly.’

NHS England confirmed the report was a summary of NHS 111 performance over Easter.

A spokesperson said: ‘NHS England have added another assurance step into the process which involves a group of senior managers in NHS England reviewing that sites are ready to launch and able to deliver a quality service before they go forward. We are still aiming to complete rollout across all England by June 2013.’

Pulse Live: 30 April - 1 May, Birmingham

Pulse Live

Pulse Live offers practical advice on key clinical and practice business topics, as well as an opportunity to debate the future of the profession, and a top range of speakers includes NICE chair Professor David Haslam, GPC deputy chair Dr Richard Vautrey and the Rt Hon Stephen Dorrell MP, chair of the House of Commons health committee.

To find out more and book your place, please click here.

Readers' comments (16)

  • Facts, figures and interpretation. So what does the national strep demonstrate. A sharing of information as close to real time over a busy weekend, by all providers and commissioners. Pulse have demonstrated their interpretation, but is it really a reflection of the true context. Is the longest wait a reflection of the first attempt of call back or the last attempt, which can be upto 6 attempts before a call is closed? Are they reflecting on high or low priority calls? Isn't it more important for each case to be reviewed to ensure that a quality assessment and outcome was achieved for each patient....

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  • Heard any claptrap from Messrs Hunt or Howe recently? Thought not. They are keeping an unusually low profile...

    As a dedicated OOH GP I see the shortcomings of NHS Imbecilic on a nightly basis:

    A terminally ill patient dying in pain because NHS Imbecilic was apparently not able to put the call through for more than 12(!!!) hours.
    A base visit for an expected death - you guessed it: DNA'd...- and numerous base visits for patients from nursing homes.
    An "eight minute" 999 ambulance for a well known 25 yr old uncompromised frequent attender with palpitations and "heart racing".
    An eight hour wait on an ordinary Wednesday evening for a young patient with a UTI only to be triaged inappropriately into an 'urgent' base visit.

    In addition patients' names, addresses or surgeries are frequently documented incorrectly - by people who can't even spell Paracetamol ("Paraceptimal" [sic!!!]) - which means that their own GPs will not get any report of the OOH encounter.

    Our local hospitals have declared an unprecedented Major "Internal" Incident because of a 50% increase in attendances.

    I hear "teething problems" once more and I will personally ensure that there are no (front) teeth left!

    Would we want our loved ones to have to endure this 'service'?


    'nough said...

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  • Re Michael Weymars entry. Agree all very concerning cases. Would suggest you feedback all these cases to your local 111 so that they can carry out a full end to end case by case audit. Also important to look at if some of these cases were handed over to the OOH provider were they meeting their KPIs.
    Re increased activity being driven by 111 in your local A&E, would suggest that you do await a full report prior to speculating. In addition, the bigger picture is that there has been increased activity across all urgent care providers for vral related conditions especially URTI and gastroenteritis, just ave a look at the latest health protection agency reports, so even primary care needs to continue to brace itself over the next few weeks as it has definitely been busier for everyone.

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  • Who on earth thought of putting lay people with no medical knowledge directed by a computer ,assessing the most vulnerable .What about ongoing problems? Even when raise the issue have no contacts that want to address.
    Like NHS Direct & many A&Es there is no Dr in charge for the discretionary issues .Therefore noone wants the risk so false economy. I have declined ambulances because of this as have a procedure with heart symptons that only I & Specialist can make.How the incidents are misreported also shows how questionable system is disregarding history.Fortunately I have been able to give mine, if I was comotose oh dear.

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  • And guess who'll be blamed for this by the Daily Mail.Prepare for another media onslaught comrades.

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