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Independents' Day

NHS 111 overhaul to ensure service 'definitively manages' calls

NHS 111 call handlers will have access to patient records and more clinical support under a major revamp of the urgent care phoneline announced today.

NHS England said it would release a new service specification for NHS 111 over the next six months designed to ‘definitively manage’ patients’ problems rather than simply providing advice.

NHS medical director Sir Bruce Keogh announced the move, which will see call handlers being able to directly book GP appointments and allow patients to speak directly to a nurse, doctor or other healthcare professional ‘if that is the most appropriate way to provide the help and advice they need’.

Pulse reported last month that CCGs had been blocked from securing permanent arrangements for NHS 111, after NHS England halted any reprocurement of the service until April 2015.

But Sir Bruce promised that the new service specifications will be announced within six months in order to prepare for a full rollout from 2015/16.

The revamp follows a troubled start to the helpline, which has led to the biggest provider NHS Direct pulling out of NHS 111 contracts, and GPs raising concerns that non-medically trained call handlers are directing more patients towards urgent and emergency services.

However, under the new proposals, there will be teams of medical professionals working with the service to provide far more opportunities for patients to speak to clinicians.

The report stated: ‘We must help people with urgent care needs to get the right advice in the right place, first time. To achieve this, we will greatly enhance the NHS 111 service so that it becomes the smart call to make, creating a 24-hour, personalised priority contact service.’

‘This enhanced service will have knowledge about people’s medical problems, and allow them to speak directly to a nurse, doctor or other healthcare professional if that is the most appropriate way to provide the help and advice they need. It will also be able to directly book a call back from, or an appointment with, a GP or at whichever urgent or emergency care facility can best deal with the problem.’

The report added that it is aiming within the next months for ‘the completion of the new NHS 111 service specification so that the new service (which will go live during 2015/16) can meet the aspirations of this review’.

Professor Jonathan Benger, NHS England’s national clinical director for urgent care, said the aim was for clinicians to ‘definitively manage’ patients’ problems.

He said: ‘At the moment 111 is performing at the highest standard. The vision we have of 111 is it should be a more comprehensive and effective service. We are trying to move it away from an advice-led service giving advice about what you should do next to one where you are definitively managing the problem for that patient.’

‘So a patient rings up and if the problem can be dealt with over the phone, it is dealt with over the phone. That telephone call should do its utmost to resolve that need.’

Dr Richard Vautrey, deputy chair of the GPC, said he was pleased there would be a ‘better balance’ between lay and clinically trained call handlers, but was sceptical about access to patient records.

He said: ‘In reality, access to a patient’s full record often does not make much difference in management of patients because it is the urgent presentation that needs to be dealt with, and clinicians will have the experience to do that and make the right decisions.’

Dr Agnelo Fernandes, urgent care lead and national clinical commissioning champion at the RCGP, said there were ‘workforce issues’ around using more clinicians.

He said: ‘Clinicans are in short supply so if you want to develop models that are on a huge scale, you need to know where the clinicians are going to come from. If it is GPs, where are those GPs going to come from?’

Readers' comments (8)

  • "Slipped in bath 2 weeks ago and injured chest - Still in pain - Advised to attend A&E within 4hrs". Thats the 111 b*ll*cks management I met first thing this morning.

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  • Mu old mum used to say to me...

    "Son, if it aint broken, don't fix it!"

    Usually after I took apart a clock or something...

    NHS Direct WORKED!


    No another sticking plaster on the mortally injured patient!

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  • So who is in charge of it this time as those in charge last time were opbviously incapable of ensuring a service that could 'definitively manage patients' which i understood to be the whole point rather than being an advice line! A lot of time and money was wasted with incompetent implementation who is to be held accountable or are they to be given numerous goes to get it right? Who failed to see that it would fail last time?

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  • Let common sense prevail

    By further developing NHS111 we are now effectively saying 'Your NHS is open to you 24 hours each day (for anything)'. Before doing this, perhaps we should assess whether the country can afford to offer this service. It is fine to say that the call handlers will be trained to 'definitively manage' the callers, but that is rubbish. They will refer their cases to clinicians, so effectively we will need clinicians available 24/7, and that is not possible with our current level of resource.

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  • Whatever next? Stop messing around at the edges and put out of hour care back to locally managed services and routine GP care from 08.00 to 20.00 hours. There should be no problem with one GP starting at 12.00 and finishing 20.00 to provide urgent duty GP care in the evenings.
    Also making better use of experienced nurses who can do much of the triage, assessing and care for a considerable number of patients.
    I am a very experienced nurse with considerable triage experience in NHS Direct and Wiltshire Medical Services and offered my services to GP surgeries but only 2 out of 10 bothered to reply let alone offer an interview.
    Locally commissioned and provided services, using the correct skill mix is the answer if only people would be more innovative and think out of the box!

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  • 11:13 - Where do you think there is spare capacity for GPs to provide 12-20 extra hours? I've just looked in the surgery car park and there still isn't a money tree to pay you let alone the reception staff I had to make redundant last year. If 'experienced' nurses don't understand the situation then god help us.

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  • So now NHS 111 callhanders are to have access to patient records?

    These non-clinical admin staff who work to an algorithm? Who wouldn't have a clue what most medical diagnoses actually mean on their own much less in combination?

    And they're going to spend ages trawling through the record whilst patient in distress holds on awaiting a response?

    Nightmare all round.

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  • I refuse to allow 111 services and pharmacists to have access to my medical records.
    The more folk that can access records the greater risk of criminal activity.
    The internet is not safe, but neither are human beings trustworthy … sad to say!

    Where will the GP's some from to manage 111 services, will we be able to understand them and couldn't they provide a better service working in a GP practice seeing more patients?

    I would never use a 111 service simply because I have no trust is unqualified folk running it, with or without doctors present.

    When you are very unwell, all the questions adds to ones anxiety levels and time costs lives!

    Whilst 111 may be able to book GP appointments, they can only do that if GP lists are open to booking, sone restrict pre booking to a couple of weeks ahead. We will reach a stage when urgent cases going directly to their GP cannot get appointments.

    Educating the public has to be essential! Watch the program about Kings College Hospital, a major trauma centre and see the patients that turn up with minor injuries e.g. a man that had a splinter in his thumb for one month, drunks, folk with very minor injuries and we can see where the problem arise!

    Rather than meddle in so many areas, the NHS should have been looked at from its very foundations right to the top levels rather than run a GP bashing exercise!

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