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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)

  • 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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