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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)

  • And lots of ear ache from patients for practice managers who are appparently supposed to be able to fix this with a magic wand. Why are lessons not learned from previous debacles? I despair or would if I had time. I and I am sure my Practice manager colleagues have enough to do without taking the flak for this fiasco. Simply not good enough

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  • As a GP Trainer and regular OOH GP in Yorkshire for the last 8 years I have had much frustration with the service and sad to see that it has got worse after NHS Direct, something that was unimaginable.
    It's worrying to see the ambulance service, who actually run the 111 service aswell, under tremendous pressure as 999 ambulances are being sent for completely inappropriate cases despite the patients insisting they only rung for advice or an appointment, yet an ambulance is sent. I have seen countless cases of inappropriate 999 ambulances.

    Speaking to the poor ambulance crews they themselves feel frustrated when management doesnt take on board their concerns that they see on the shopfloor.

    The local OOH service was (pre- 2009) truly a model for the rest of the country where we had high quality triage by experiences nurses who could discuss a case with the visiting GP and vice versa.

    At present the service seems to be about targets and numbers and the actual reason for the whole system, the poor patient, seems to be forgoton.

    A root and branch overhaul is needed putting the patient first.

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  • There can be only one reason why the DoH have introduced NHS 111. The call handling centre is one of the costliest bits of OOH provison, so by offering a national service, it reduces the cost of market entry for the private sector providers who can then outbid local GP co-ops.

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  • As an overworked frontline Paramedic the 111 service has only served to increase the workload - something 'has to give' eventually and I hope that I'm not out 'on the road' when it does! I just don't think you can assess a patient by 'phone either - its a disaster waiting to happen. I definitely agree with the above post - the patients do not come first - targets do!

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  • Understanding the 111 service and its true aims. The patient, their experience and journey navigating through the various healthcare systems on a 24/7 basis is a key aim of the service. At present it quite rightly is utilised more in the out of hours timing., as primary care is available during the day upto 18:30.
    A number of 111 service providers are increasingly using the same IT tool to support call handlers to advise the caller of where to go at the time of their call, being dependent of what is open to best meet their earth care need. Equally a number of ambulance services are using the same tool for their 999 call assessments...

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  • If it is not broken don't try to fix it. Who is gaining from this 111 innovation?

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  • The idea behind 111 was not bad. Unfortunately it got highjacked by the DoH into a cost saving exercise & they now have a lot of egg on their faces.
    What this fiasco demonstrates is what a good job OOH providers & the GPs who work for them have been doing hitherto. Having two different organisations responsible for providing OOH cover is a recipe for misunderstandings & mistakes. Patient safety has been compromised. The DoH should admit they have got it wrong & hand back to OOH providers the responsibility for triaging OOH requests.

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  • Telephone triage is extremely difficult. Just yesterday a visit I triaged on the phone was much more unwell that I anticipated, luckily I was not busy so there was no delay attending.

    Every GP knows it is more difficult than seeing patient's in person, every GP registrar is told that when they are training. Why does the DoH think it can be done on the cheap?

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  • April 12th 6:36pm obviously has insight into the system. I wonder how many others who post are as well informed?
    Implementing 111 for me has provided a fabulous insight into the unscheduled care landscape - there are huge problems, the old ways of working no longer work AND are unsafe at the volumes experienced in OOH care. The potential of the new ways is clearly misunderstood and are not universally available yet for long enough. As a result it is impossible to assess the true risks and benefits and so on....the SCHARR report feels inconclusive overall.
    For what it is worth I think It would be a disaster to kill it. If we had to replace 111/OOH the best option is going back to GP's doing their own 24 hr care for their patients again....and the DH could impose that if needed....it will be interesting times over the next few months.

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  • Who is gaining from 111? Ans The patient. "If it ain't broken, don't try to fix it". What if you don't actually see what is going on in the bigger picture because you have stayed so "insular" in your views. It is good to examine what is going on with the 111, and by so doing you will begin to realise that no other service introduction has been put under the microscope both per, during and clearly rightly so post implementation. Nor has any other service had such a high degree of clinical oversight and scrutiny....

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