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A faulty production line

Earlier medical advice to underpin revamped NHS 111 service, claims NHS England chief

Exclusive NHS managers are considering a major change to the way calls are dealt with by the troubled NHS 111 service, with advice from a medically trained professional introduced at a much earlier stage, Pulse has learnt.

In a change to the computer algorithm specially developed for the urgent care line, a senior official has told Pulse that NHS England has found that introducing clinical input earlier is ‘very efficient for resources’ and that the body was looking at how to implement this into NHS 111.

The helpline has been heavily criticised by the medical profession for unnecessarily referring patients to GPs and A&E services, and the GPC has repeatedly called for more clinical input in the service.

The algorithm 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 - and was signed off by the NHS Pathways group, which included representatives from the RCGP. It is currently used across all NHS 111 sites.

But Pulse has learnt that NHS England is considering major changes to this algorithm after numerous problems with the service, including commissioners in the North West and the West Midlands having to reinstate triage services from out-of-hours providers, calls going unanswered and 22 serious incidents in its first month of operation.

NHS England announced in April that it was undertaking a review of the new three-digit number for urgent care over the past few months and, speaking to Pulse, NHS England’s director for acute episodes of care Professor Keith Willett, revealed it had found early clinical input into the pathway is ‘not only effective’ but ‘efficient for resources’.

Professor Willett said: ‘We are reviewing 111. One of the things we know is that getting clinical input early in the decision pathway is not only effective, it is also very efficient for resources, and we will have to look at how we do that.

‘Quite clearly with the hundred million calls on the urgent care system per year we aren’t going to have a doctor answering every one of them, but it is about making sure that when key decisions are made – and that may be about transferring someone to hospital – there is a medical input where it is appropriate.’

GPC negotiator Dr Peter Holden said that a move to use more doctors or other clinically trained staff such as nurses would work out cheaper in the long run.

He added: ‘If you have a more senior d on NHS 111 then you will have more accurate triage. The Government would realise that if 99% of the decisions were right and 1% were wrong then it would save money.’

Dr Nigel Watson, chief executive of Wessex LMCs  and a GP in the New Forest said a review of the NHS 111 algorithms would ease GP workload.

‘A number of GPs in our area have patients who were told by 111 to see their GP. But often the patients wonder why they have to see the GP, and then the GP wonders the same thing. It’s a waste of time for patients and for GPs.’

Readers' comments (5)

  • why not call it NHS Direct?

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  • Because NHS Direct has acted so poorly in the matter that it is very quietly being run out of existence.
    111 has other providors delivering the service- ambulance services, social enterprises, previous GP co-ops- so when you get the stats about good 111 performance , they are true but almost entirely relate to those providers.

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  • Vinci Ho

    So it took such a long 'pathway' before you realiazed clinical input from a professional is essential . That demonstrated exactly how short sighted the government was:
    Yes , perhaps you thought potentially you could save money by using 111 on adopting non professionals to answer the phone . Then you open the floodgate to expose the actual complexity of the problem . The money you could save would have to be reinvested into the system to maintain efficiency . Overall , it is difficult to know how much money can really be saved .
    Truth is improving efficiency involves only initial 'clearing of the lockers' and then resources saved have to be reinvested.
    This is common sense . If that is not even taken on board , you are either stupid or otherwise trying to blind people with politics and spinning .
    ' Only two things are infinite , the universe and human stupidity and I am not sure about the former.' Albert Einstein....

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  • "The algorithm is operated by non-medically trained call handlers..... and was signed off by the NHS Pathways group, which included representatives from the RCGP"

    So the RCGP was part responsible for this fiasco too.Now that has been kept very hush hush hasn't it?

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  • NHS Pathways - the clinical assessment algorithm was developed by the NHS and is maintained by the NHS. It is overseen by a national clinical governance group, including GPs and representatives from the Royal Colleges including the RCGP.

    For more information go to:

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