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Dr Chaand Nagpaul: 'NHS 111 has been an abject failure'

Read the full reaction from GPC chair Dr Chaand Nagpaul to NHS Direct’s decision to withdraw from all its NHS 111 contracts.

The implementation and planning of NHS111 has been an abject failure.

NHS Direct struggled to cope with the volume of calls it was receiving despite having years to plan for the launch of NHS 111. Other already overstretched services, such as GP out of hours providers, have had to step in and undertake the workload that was supposed to be dealt with by NHS 111. It is worrying that patients had to wait twice as long as recommended for their calls to be answered.

Sadly, many of these failures have occurred in many parts of the country.

The decision by NHS Direct to seek a withdrawal from its contracts to provide NHS 111 reveals worrying flaws not just with the tendering process for NHS 111 contracts, but for how contracts are awarded and monitored throughout the NHS.  The Department of Health gave the BMA written assurances that there would be strict safeguards in place to ensure that NHS 111 providers would have the clinical and financial ability to deliver a safe, effective service to patients.  

A number of local GPs and the BMA raised concerns during the tendering process about the low nature of some of the successful bids which were ignored.

If this failure can occur with NHS 111, there is no reason why it could not happen with other parts of the NHS, as demonstrated by the recent investigation into the provision of out of hours services in Cornwall. Tonight’s Dispatches programme is likely to highlight a further catalogue of mistakes across NHS 111’s operations. We cannot have a situation where patients are placed at risk or suffer from substandard healthcare because contracts have been improperly awarded.

The Government should expand its review into NHS 111 to include an examination of what went wrong with the tendering process, particularly whether providers were given an advantage if they put in the lowest bid. There must be a firm commitment in the light of this failure from ministers that the procurement process across the NHS meets strict quality standards and happens safely and effectively.

If NHS 111 is to recover it must receive proper funding and be closely integrated with local NHS services. The Government must review its competitive tendering approach and instead look towards an integrated model based on cooperation between local services.

Dr Chaand Nagpaul is chair of the GPC

Readers' comments (3)

  • Public procurement of services is done (to compress into a few words) by asking a set of questions about the 'quality' of the proposed service and supplier and asking for a price. Responses are marked and scores awarded. There is then an attempt to mash together scores for price and quality. This is seldom done well and anyone who believes that a such questioning process largely based on paper and carried out by people who often haven't done such a thing before can result in a good result can only be described as a politician.
    Oh yes, and remember that a) it is practically impossible under EU regulations to exclude anyone for previous substandard performance; and b) coming up with a workable performance management regime is a very high order skill indeed. Big Outsource rules OK.

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  • I was a Senior Nurse with NHS Direct for 7 years. As a clinician with advanced medical knowledge I was able to spot signs of possible life threatening illness like abdominal aneurysm, suspected intussusception, cardiac arrest signs etc....As experienced Nurses, we kept people from clogging up A & E with sore throats . Unfortunately, during the build up to the 111 service, I and many other Nurses saw this coming and knew it would be set up to fail dismally . We had no respect for our knowledge and Code of Conduct . We were increasingly bullied out of our jobs because we were deemed "too expensive", managers at NHSD made it so difficult at work with unrelentless demands and injustifiable objectives that many Nurses were in tears during shifts or on long term sick with work related stress. Our calls were reviewed to the "nth" degree, we were constantly harrassed to meet unrealistic targets of 7-8 calls an hour ( try doing that when you have a suicidal person on the end of the line for 45mins ) the ultimate humiliation was being timed on toilet breaks. NHSD & 111 are both money driven, statistic mad businesses & 111 has unfortunately reaped what it has sowed by replacing highly experienced clinicians with call handlers .

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  • Further to my comment above. The line beginning " We had no respect..." should read "They had no respect". An error on my part as I was quite angry whilst writing the comment !

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