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NHS 111 implodes as GPC withdraws support for urgent care hotline

The GPC has warned that the launch of the Government’s flagship urgent care hotline will go ‘very badly’ from 1 April, with launches of the service in London, Manchester and Birmingham already descending into chaos.

GP leaders across the country are warning that patient care is being hampered by the service due to improperly trained staff, a lack of personnel, long waits and out-of-hours GPs having to take on extra work.

The GPC will write to the NHS Commissioning Board and the Department of Health to request that the national launch of the service to replace NHS Direct from 1 April is delayed.

GPC chair Dr Laurence Buckman said he was concerned that unless the launch was delayed, it would go ‘very badly’.

He said: ‘We are very concerned that when the service goes live on 1 April, it will not be able to cope with what will happen. It clearly can’t cope in Manchester and Birmingham, how is it going to cope when London goes live?’

‘On 1 April everyone will be forced to use it and we think it will go very badly.’

In Manchester, BMA representative and LMC chair Dr John Hughes said a ‘soft launch’ of the NHS 111 system in his area failed last night, with waits of up to 90 minutes.

He said: ‘The service soft launched yesterday. Things were reasonably quiet until early evening. I spoke to one doctor who was working his shift at the out of hours service. At 9.30pm, they realised they were getting very few calls through.

‘They then got a call from a carer who had been on hold with NHS 111 for 90 minutes who was with a 90-year-old patient. She had to cancel appointments with her other patients because she did not want to leave. Shortly after that, it became clear that the ambulance service was becoming overwhelmed by calls.

‘The out-of-hours service across Manchester rightly took the view that the situation across Manchester was very dangerous and they took back control of the call handling. But they are not resourced to do that as many of their staff were [transferred] to NHS Direct. 

‘I don’t think the services will cope from 1 April. We didn’t think it would cope with the soft launch.’

Dr Stewart Kay, the GPC’s lead in south London, said the situation in areas across London was a ‘shambles’.

He told Pulse: ‘The soft launch in Lewisham, Southwark and Lambeth was supposed to start last Thursday.

‘With 24 hours’ notice we were told that this launch had been cancelled for the third time. This time it was because NHS Direct were not able to handle the call volumes for Bromley, Bexley and Greenwich. The Lewisham, Southwark and Lambeth population is at least twice that.’

‘They have wrecked the system that was hitting all its targets on times and delivering a good service and put in a service that doesn’t work at all.’

The NHS 111 rollout has been beset with problems. Last year, official figures from pilot sites showed an 8% rise in ambulance attendances in areas of the country that piloted the Government’s new urgent care number over a year, compared with 3% in non-NHS 111 sites, leading to GPC criticism of the ‘indecent haste’ the scheme had been rolled out.

The DH also invited CCGs to apply for a delay to the rollout last year after expressed by the GPC, NHS Direct and other providers that the April 2013 deadline for the rollout of the new service was too tight for some CCGs.

Pulse revealed earlier this week that GPs were being dumped with following up any patient who contacts the Government’s new urgent care hotline more than three times over a certain period, in what amounts to a ‘charter for queue jumpers’ according to the GPC.

Health minister Lord Howe said: ‘To ensure that patients get the best care and treatment, we are giving some areas more time to go live with NHS 111 while we carry out thorough testing to ensure that those services are reliable.

‘The NHS Direct service will continue to be available to callers in areas where the NHS 111 service is in the process of being introduced.’

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Readers' comments (41)

  • Vinci Ho

    So duty of condour , where should we report???

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  • The way it's going we'll have to take a class action against Jeremy Hunt in European court......

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  • So who will take responsibility for this and lose their job. You do pilots which fail and then plunge on regardless endangering patient's lives and wasting huge resources. Someone must go presumably the headman.

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  • I witnessed the "soft go live" of NHS-111 from the control room of the Liverpool GP OOH service. On a normal Thursday between 18.30 and 2200 we'd have dealt with about 60-70 calls. Last night there were 13... and it took 25 minutes for a 111 call to be answered at around 7pm.

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  • All West Lancs GPs had to switch their call answering back to the proven and locally run GP OOH service late last night.
    Complete disaster. If GPs hadn't then serious mishaps could have happened.
    If we GPs had delivered a service like this we'd be hauled in front of a service committe or GMC fitness panel.

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  • We have has the 111 service in Southampton for a while.The clinical information on the paperwork is appalling. We have fedback the problems but the only answer is 'it cannot be changed, it is a centrally run service'.
    I do not trust the DoH to run anything well.

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  • I'm in Manchester and the organisation and communication has been truly awful. It was not surprising to hear that they had to abandon their launch last night (the first night of operations) and give responsibility back to the pre-existing out of hours services. This is an enormous project and yet I would say it has been one of the worst organised changes I've come across in 15 years in the NHS. Heads should roll.

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  • Heard Buckman on the radio this morning - shame no one thought to ask why OOH was marketised in the first place - sharp negotiating by lazy GPs - now its someone else's fault

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  • Actually, the government insisted that the service could be delivered for 6k/principal. We said it couldn't and that GPs were effectively subsidising the OOH service from their own pockets / working for free. We were right.

    You might want to review your history of what actually happened.

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  • Anonymous 1:30 - clueless and obviously not a GP

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  • NHS 111 is a good idea implemented badly. The problems are 1/ that lay people using Pathways are doing the triaging. Inevitably this is going to be very risk averse - much more so than NHS Direct, and 2/ the CMSDOS ( the directory of services) becomes very complex when implemnented over a large area - this should have been developed and run locally and kept simple. This and the lay advisors mean that calls to our OOHs have gone up 30% plus, with A+E attendances also up. We have had to implement a second tier of GP triage to deal with the vast number of calls, many by advice. We are also having to invest in a Directory of Service that is comprehensive and regularly and pro-actively updated. This is of course costing more money than the previous system. NHS Direct front ended our OOHs service and managed to deal with approx 20% of callers by advice - although we know that this servicde was not without its problems. I met John Oldham at a presentation a year or so ago and warned him that NHS 111, if implemented as it subsequently has been, would result in increases in call volumes and additional costs due to the compensatory mechanisms that GP OOHs and A+E services wouold have to implement to manage the increased patient flows. For me an effective telephone service directing patients around the complex acute care system, giving advices or appts when appropriate (including to minor injuries units and Urgent Care Centres) could have revolutionised the sytems to the benefit of patients and providers alike. This is a real missed opportunity.

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  • I'm a GP in Bexley and an elderly lady told me that she spent over 30 minutes on the phone essentially being triaged, then ended up being put through to the local OOH team. She had to wait for a doctor to call her back, who asked even more questions - only this time it took 2-3 minutes before the GP decided she needed antibiotics for a UTI. Quote "The people (111 staff) kept me on the phone for over half an hour, and were asking me all sorts of questions...some of these questions were very strange like did I have pain in my chest or bleeding from the back passage. I tried to tell them I had a water infection. They didn't sound medical to me!" Enough said.

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  • some background information for anonymous 1.30pm
    I was medical director of our local GP co-op, we met or exceeded all the quality standards that were in place and our local health authority were always impressed by our work.
    In 2004 with the change in GP contract we had to bid against 2 other suppliers for the local OOH contract. we didn't get the contract. It went to the cheapest bidder. I saw the figures and told anyone who would listen that OOH could not be done properly on that amount of money.I was ignored but rumour has it that a bail out sum of tens of thousands was eventually needed.
    The Dept of Health seems to think OOH can be done on the cheap, it cannot.
    I don't do OOH work anymore, too disillusioned.

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  • I am a GP partner and work OOH for two different providers over the weekend. Recently there has been acute worsening of OOH but thats nothing compared to the nonsense that comes out of 111 soft launch with URTI`s being rushed with 999 as "breathlessness" while torted testicle being advised to contact GP routinely. The ambulance call outs have been significant of late. The S*** has hit the fan.

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  • One of our partner does OOH and he was telling us the patients were complaining they had to be on phone for 47 min - no, they weren't put on a que, someone actually talked to him for 47 min before deciding a medical input was needed.

    Most things I'll decide within 3min if the patient needs a physical r/v, treatment or just advice. My tirage telephone calls are placed in 5min slots!

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  • One day, when the dust settles, we can review the concept , the tendering process, the authorisation by the DH, the preparation before launch and the risk to patients, most of all, but on a day when the OOH service has been lambasted by the Patient's Association as poor ( in a self selecting survey) I would like to pay tribute to the doctors, nurses, call handlers, drivers and staff of OOH organisations like ours who put patients first and stayed behind to work. Their dedication was truly awe inspiring.
    Many of the excellent, sensible, well trained and knowledgeable staff we lost due to NHS 111 have , without a moment's hesitation, agreed to come back and work for us now we have to take back the service.
    When will the Government realise that cheap is not the same as cost effective and safe or has noone in the DH read the Francis Report?

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  • Vinci Ho

    Thank you for all your comments.
    'Only two things are infinite, the universe and human stupidity , and I am not sure about the former .'
    Albert Einstein

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  • GPs should never have accepted the superficially attractive package by Labour's Health Secretary, Hewlett. Once that happened the moral ground among GPs established for 100 years was lost with the result that the medical profession's clout became seriously undermined. What has now happened is a direct consequence of Hunt's attempt to recover a quality health service without him having the skills to achieve his target.

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  • NHS 111 is an absolute shambles in Liverpool. These half baked ideas mess up everything and only increase our work load. Today, this evening, I had to stay in my surgery till after 19:00 hours, trying to sort this problem out. The IM & T department were panicking, despite being told that the system was not working. I still am not sure if the system works. We have had to redirect calls to the Out of Hours again. I just fail to see how such stupid plans get passed by the Mandarins above, who screw things up big time, have no responsibility towards the general public, get paid fat salaries. I despair!!!

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  • If OOH triaging is to consist of a lay person following a computer alogorithm then you can make the service even cheaper by outsourcing these calls to India.NHS111 is the thin edge of a wedge.

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  • "Health minister Lord Howe said: ‘To ensure that patients get the best care and treatment, we are giving some areas more time to go live with NHS 111 while we carry out thorough testing to ensure that those services are reliable."

    Lord Howe, you're talking utter claptrap - in the usual incompetent fashion so characeristic for politicians...
    And, more importantly, you - yes, YOU!!! - are among the people responsible for putting patients' health and life at risk!

    I have been a dedicated OOH GP for the last eight years. It doesn't matter whether I like NHS 111 or not - I hate it!!! What matters is what sort of care the patients get.

    What I have seen over the last few days - and what is inherent in NHS 111 - is very, very scary!!!

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  • I repeatedly raised at local 111 meetings that I felt they wouldn't cope with potential peak demand only for my views to be poo-pooed and reassured that suitable modelling had assured the commissioners that they would cope!!!!! With 25 yrs plus out of hours experience including a flu epidemic I am now sad to see my misgivings being proved correct. In our area they have also changed out of hours provider from the 1st April. I am glad I no longer have to respond to the screams for help over the Easter holiday that will eminate from the Health service locally.

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  • The fundamental misconception politicians have about triaging is that for them it is a 'bottom up' process, non-medical unqualified people passing up problems to qualified professionals dependent on severity. The opposite is true however. Triaging should be done by the most experienced clinician and passed down the 'chain' according to expertise and experience. That would of course be unaffordable within current systems, which is why NHSD and 111 and whatever they will be replaced by in due course will be destined to fail.

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  • NHS 111 is just the canary in the mine.

    Wait till 1st April and beyond when everything starts to fall apart.

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  • Vinci Ho

    Keep sending your comments about 111 throughout the weekend.
    Editor , please let people do so before 1/4/2013
    All are welcome......

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  • It is a dangerous disaster waiting to happen. I wonder who the Daily Wail will blame

    A) taking up to an hour to triage complex cases such as dysuria and frequency.

    B) If certain 'key words' are used by the callers such as ' I've been coughing and have a TIGHT chest' this will trigger a 999 call. The Ambulance Service will grind to a halt.

    C) Irate patients then blame the GP who has chosen to offer his/her services to the system. GPs will give up OOH in droves unless it is their only source of income.

    I really don't think politicians HAVE ANY IDEA AT ALL just how finely balanced the system currently is. It could all implode at an astonishing rate.

    I retire early in 2 weeks time. Good luck to those left to carry on.

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  • The 111 concept is fatally flawed, NHSD has never got through a winter without their systems collapsing at times of peak demand. Up to now GP OOH services have been able to flex their resources in responses to levels of demand up to 3 times normal, usually during the winter flu season and bank holidays. Not only is the Pathways system less efficient at managing demand, the onerous training needed means that no provider will be able to train, and keep trained, enough staff to cover peak times. But once 111 is rolled ot there will be no more OOH call centres to cope when the big call centres are flooded. Heaven help the ambulance and ED services.

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  • It is a disasteous concept in practice. Principles are excellent.
    issues:
    1. system clogged up by repaeat prescriptions
    2. OM fro e.g slotted as urgent appointments and when real urgent cases need to be see- pts are double - tripled booked
    3. triage staff- inexperienced....pathway disposition in question. e.g pathway say contact GP in nxt 12 or 24hrs- pts regardless are booked ito same day slots.
    4. more disposition to 999
    5. walk-in an issues as teh delay mounts, pts walk into centre. Then there is ' hilaruious' situation where these pts neeeds to be seen with 20mts!!!

    we blamed NHS redirect, this is worse.

    Something needs to be done, but who is brave enough to challenge? my proposition--> all OOH drs to withdraw their services and this will concentrate DOH's mind.

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  • I worked for a PCT led OOH - all longstanding local doctors committed to a quality service, on the day that NHS111 was introduced we were TUPEd to a social enterprise . Hard to tease out which bit is causing more problem - suffice to say the patients are waiting far far longer than before ..

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  • It is also causing problem in the surgery too.

    We've just had to dedicate my office manager to check on email (which I'm told will be sent to us by 111 to alert us of their advice to patients to contact us in X hours). So, instead of concentrating on something useful like ensuring phones are being answered and managing receptionists, she'll have to keep 1/2 a mind on checking emails. How wasteful is this!

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  • Peter Swinyard

    What a shambles! Communications back from 111 also dire with vast expanses of useless verbiage and any salient facts well hidden. I'm off to West Wales for a week at Easter. At least there should be a doctor contactable there if I have an MI etc.

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  • Patients we have spoken to like the single point of contact idea in principle, but I await the outcome of the roll out of 111 in our area with trepidation. Reports thus far suggest extensive delays .... I agree with H Blumenthal that effective triage needs to be done by experienced clinicians . Electronic communications which consist of streams of protocol verbage, from which it's very hard to sort out the wheat from the chaf, are at best unhelpful and at worst add to the risks..

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  • Can someone explain to me why this has not hit the national news? Or are the press only interested when they can blame GPs?

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  • In answer to John O'Malley, the reason this has not hit the national news is simple.
    This is the largest foreseeable mess that the medical profession leadership has been warning about since inception.
    To run a story that confirms the clinical concerns where genuine , altruistic , patient focussed conflicts strongly with the "cold war "denigration campaign that successive governments have run.

    It seems worryingly clear that the political strategy to answer to the conundrum of how you run an NHS with "costly" highly trained medical staff is to get rid of the medical staff.
    This highlights the fact that when you do the quality plummets.
    In a just world this should be front page news and certain red tops backed off the medical profession forever.

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  • Silly me thinking this is the sort of issue the Press were fighting to be able to report on in the future.

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  • Patient care has been grossly compromised in this foolhardy rollout of a system.There is a clear lack of understanding in the leafy pastures of the Home Counties of the huge demand being thrown at Primary care & particularly Unplanned care across the country.And to think somebody somewhere thinks that this service can also manage"in hours" calls to GP practices! At what point will we be listened to?

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  • OOH in my opinion should be dealt with by the patient's own GP service. Money should be made available for practices to finance this instead of call centres/OOH/ NHS Direct / inappropriate A and E attendances and 999 calls. I am sure this would be far more cost effective. They could arrange a rota service as most are in group practices. Not only would you have access to all the patient data you would likely know the patient. This would be far safer. People who abuse the "OOH" system could be educated regarding their actions-- like they used to be told prior to new contract. GP's could learn what is needed from their local services--For instance if the reason for high level of night calls is due to poor day time access and other services. Unless OOH care returns to GP'S the situation year on year will get worse. I do not know how the country affords all these costly services. We have a system currently where many of the public do not know what to do or where to go--despite multiple options. I also feel strongly that GP's/Health Professionals should educate re minor illness and self management and advise patients to take responsibility for repeat scripts-- especially at holiday periods so OOH is not further stretched by inappropriate calls. It seems since the new contract GP's feel it is no longer their responsibility ? as they do not pay for service. Employing another GP in every practice would no doubt be cheaper than the implementation of 111--OOH etc. Why do administrators never talk to the people at grass root level?

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  • Why do intellegent people not look at any new suggestions like 111 and see the potential for disaster if not organisated from the bottom up and look at every level for potential problems. It seems that intelligence goes out the window. Who will deal with this failure -the long suffering practices!!!

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  • I agree with anonymous at 1:13. We need as GPs to take back OOH care for our own practices, much better deal for patients and eventually for the doctors as well

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  • 111 is the gateway to GP out of hours service.... but only if you are the patient, or you are standing next to the patient. If you are not with the (elderly) patient then "no assessment can be made". No alternatives are offered. So the caller then has to travel to the patient - by which time the patient may be much worse.

    Did the designers of the 111 service not consider this scenario. My elderly parents will struggle with this service - they are hard of hearing and technophobes. If I try to call from distance I will be blocked from accessing the out-of-hours service.

    Perhaps I should do the "wrong thing" and call 999 each time?

    Hallelujah! Progress in our time.

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  • As an EP working solely in the OOH, I have found the introduction of the 111 service to be a total debacle. Long waits for non clinical triage, are compounded by upto 20 minutes of patient questioning. the resulting 'outcomes' often not actually showing the clinicians what the patient really called about in the first place. pregnant women with obvious odeama are shown on the Q&A sheet as 2having no swelling! children who are flat and unresponsive as "unwell". its a dangerous farce! the work within the OOH centres has increased along with 999 calls. patients are at risk in this system, along with the Registration status of the professionals at the sharp end who are having to clear up this mess.

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