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GPs to work in NHS 111 call centres under NHS England pilot

Exclusive GPs will work in NHS 111 call centres as part of an NHS England pilot aimed at increasing clinical input in decisions over the coming months, Pulse can reveal.

The news, unveiled in an internal presentation document on ‘GP early intervention’ plans, which Pulse has seen, explained that the pilots are due to run ‘throughout May’.

The pilots, some of which have started already, will test a number of options for how GPs may be able to help improve the service that patients receive via NHS 111. This will include looking at how ‘clinical outcomes’ are affected by having GPs patrolling the call centre floors or by situating them at out-of-hours sites, the document revealed.

The trials are being conducted by eight NHS 111 providers across England, including the West Midlands Ambulance Service, London Central and West Unscheduled Care Collaborative, and North West Ambulance Service.

The news comes after NHS England said in November that it would add more clinical support to 111 as part of a major revamp of the service spurred by recommendations from Sir Bruce Keogh’s urgent care review, but it has not been clear to date how GPs may fit into plans. All reprocurement of NHS 111 contracts has been put on hold by NHS England in anticipation of a new commissioning standards document – to include this new guidance – the first draft of which is expected on 6 May.

And, despite the GP early intervention pilots running beyond that time frame, NHS England confirmed that they would help inform the commissioning standards document, with new evidence to be added to it as it emerged. It comes after the NHS 111 service – which replaced the nurse-led NHS Direct predecessor – has been criticised for a lack of clinical input, instead relying on lay call handlers and computer triage.

The presentation document said: ‘Earlier GP intervention in the referral process is expected to improve the clinical outcome and appropriateness of referrals in line with the recommendations of the urgent care review… This pilot will introduce a process for GPs within the 111 service to  provide enhanced clinical input to callers.’

It added that based on the pilots NHS England would evaluate ‘if the provision of enhanced clinical input within 111 delivers improved clinical outcomes for patients’ or if there was ‘any impact of earlier GP intervention on the receiving service’. The pilots will also help to ‘establish the most effective forms of early GP intervention (e.g. floor-walking vs desk based, on-site or based within GP out-of-hours site).’

An NHS England spokesperson said: ‘Some of the pilots have already started and others are due to start. NHS England will be publishing commissioning standards using readily available evidence. Where this doesn’t exist, emerging evidence from the pilots and other sources will be considered. These are commissioning standards against which local commissioners will tailor their local service specification.’

Since November, NHS England has also been consulting out-of-hours providers and CCGs via local workshops and meetings for input on the future shape of NHS 111.

Dr John O’Malley, medical director of GP out-of-hours provider Mastercall Healthcare and committee member at BMA Medical Managers Committee attended one of the events.

He said: ‘Relying on [the triage algorithm] works incredibly well in some areas and not so well in others. The crux is what level of clinical support [to add], because if you go too far you actually start reinventing the wheel.’

NHS England will also be evaluating the impact of NHS 111 on GP out-of-hours services and conducting other pilots on secondary triage by ambulances, and central access to crisis records for vulnerable patients.

 

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Readers' comments (9)

  • Vinci Ho

    Goes around the whole world before common sense strikes. I have said 111 should be part of out of hour GP service from day one.......
    Funded optimally with sustaining , this is more likely help our A/E colleagues than anything else....

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  • FINALLY.......

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  • The problem is....soon there will be no ******* GPs because of the way we are demonised, threatened, ridiculed, bullied, smeared, harrassed and stalked.

    Hunt is mad, plain and simple. Either that or this is a malicious attempt to hijack the NHS into the hands of private companies.

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  • A lot of my patients do not believe they can see a GP out of hours becasue of the media spin. I have to remind them that 111 will triage them to a GP if required and GPs as a group are still providing OOHs medical cover. Maybe with direct involvement with 111 the public will be reassured.

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  • Vinci Ho

    Truth is the government has deliberately downgraded Out of Hour GP service( which I admit needs further improvement ) and misled the public that there was no GP to see patient once the door of surgery is closed every day and weekend. It is my belief that if out of hour GP service is properly publicised and funded coupled with consistent training( consider it as a specialty) , it can help our A/E colleagues a lot.

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  • Bob Hodges

    The square-wheel must be re-invented!!

    Good luck finding anyone dafte enough to sit in a call center when OOH shifts are going empty every day thanks to NHS111 nonsense.

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  • That's odd.

    I'm sure government decided we GPs are too incompetent, over paind, lazy and ineffective to manage triage just a few months ago.

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  • Just to add a bit more.
    My big concerns are that we are not learning from the mistakes of last year. The places where NHS 111 have worked have been either where they have been integrated into the OOH services or where extensive and ongoing training in Pathways has been a priority.
    The main problem is that the primary care workforce is increasingly being stretched to paper thin with more services asking for more GPs. In one way it is a recognition of the importance of primary care but I share some concerns here that , unless we get a major rise in active GP numbers, then many of these schemes will fail.

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  • Bob Hodges

    John

    Many of these scheme will fail, and then because they've diluted the GP workforce, EVERYTHING ELSE will fail.

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