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NHS 111 providers ordered to appoint GPs to redirect cases towards primary care

Exclusive All NHS 111 providers have been told to ensure they have GPs available in call centres or available to give clinical advice at peak times to reduce the burden on ambulance services and redirect cases towards primary care.

In a letter to NHS 111 commissioners and obtained by Pulse, NHS England’s national director of commissioning operations Dame Barbara Hakin said that the plans for GP presence in call centres or available to provide clinical advice should be in place ‘as soon as possible’ to minimise the burden on ambulance services suffering ‘as soon as possible’.

Dame Barbara said that pilots of GPs working in call centres had successfully led to ‘diversion to primary care, especially GP out of hours’, as well as some diversion to A&E.

Although the letter says increased GP input into NHS 111 is a short-term measure, Pulse understands that NHS England is set to include the appointment of GPs as part of its final directions for commissioners procuring new contracts.

When NHS 111 was rolled out in April 2013, NHS England insisted that non-medically trained call handlers would be able to rely on NHS Pathways, which would direct patients to certain services based on a computer algorithm.

But Pulse revealed in April 2014 that GP presence in call centres and retriage was being investigated under pilots after the service suffered problems following implementation, including the biggest provider - NHS Direct - pulling out of all its contracts and complaints that the service was overwhelming urgent care services.

Dame Barbara wrote that these pilots showed GPs could redirect two thirds of ambulance call outs – typically to GP out-of-hours services - and were ‘a pre-requisite for the success of the process’.

Dame Barbara told commissioners they would need to appoint GPs in call centres ‘as soon as possible’.

The letter sent to NHS 111 commissioners on 23 January states: ‘I would be grateful if commissioners would work with their providers on the following priorities… a GP presence, or GP clinical advice available to NHS 111 health advisors and clinical advisors during the hours of peak demand – including at weekends and over bank holiday periods.

She added: ‘Clearly the changes need to be in place as soon as possible.’

The letter said GPs agreeing to take on extra shifts in 111 could be reimbursed for hikes incurred to their medical indemnity bill under the new out-of-hours cost cover scheme which Pulse reported on last week.

A spokesperson said: ‘This pilot will test whether action to address higher indemnity costs has an impact on providers being able to recruit GPs to new roles in NHS 111 services. We have timed this so it covers the busy Easter bank holiday period to further strengthen NHS 111 services during this time.’

Commenting on Dame Barbara’s letter, GPC chair Dr Chaand Nagpaul said: ‘This vindicates everything that GPC has said from the outset, when 111 was launched. We warned that a system of call handling driven by a computer algorithm and staffed by non-clinicians was never going to be fit for purpose.’

He added: ‘This is just a sticking plaster in the short-term, it’s not addressing the root problem of the way NHS 111 is structured, as a standalone body.’

Dr Emma Rowley-Conwy, chair of the south-east London SELDOC out of hours cooperative, told Pulse: ‘I definitely agree this is the way forward. We are still closing about two-thirds of calls sent to us by NHS 111 as “see a GP” on the phone, as well as being able to step down a large number of “urgent” to “routine”. 

‘It will be more expensive as will need more GPs, who are not cheap and are in short supply. However, one thing that NHS England seems to be trying to address is the cost of indemnity for GPs doing out-of-hours work.’

The GPC has previously said that NHS 111 disproportionately affects A&E and general practice, and recently called for NHS England to lead an urgent review of the workload pressure it was putting on GPs.

Readers' comments (10)

  • Telephone triage is one of the most difficult things to do well and safely.

    Who would have thought experienced clinicians would be needed?

    ..... oh right... everyone.

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  • As a primary care nurse practitioner I used to do the job of telephone triage for the ooh service before we were all put out to pasture and replaced with non clinicians. I personally fielded most of the calls with simple reassurance or advice about OTC medicines and management. This was nothing more than a cost saving exercise. Now, a couple of years on we are going full circle!

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  • How about cutting the crap and actually pay GP's a proper rate rather than the paltry 55-65 pounds an hour for out of hours work. Pay them a market rate the would a professional like a Solicitor, Lawyer, chartered accountant and you might some interest. Crown indemnity should be a minimum.

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  • @ 6:23

    you have clearly been a victim of crazy managers/ politicians.

    Anyone who has actually done the job knows that it is a job for experienced clinicians - and trying to down skill the role is madness and one of the biggest wastes of money.

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  • Oh dear. The letter reads like an admission of failure and incompetence without a required apology! For this failed clinician who is a dame to not have recognised that NHS 111 was not going to work is incompetence of the highest order. But will she resign? No. And with 2/3 of 111 calls ending back to primary care (the rest I'm sure to a&e) , the complete lack of value of the service is pretty clear. But this failed pilot was pushed through as a money maker for private contractors and resulted in the decimation of a trained competent Oohs workforce. The suggestion in the letter to increase "diversion to primary care" is bonkers as if we have the capacity with our block and ever reducing funding. The sooner we put a safe consultation volume cap the better. I have no issues with diversion to a&e as they at least get paid per attendance. Primary care cannot absorb anymore.

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  • This whole idea was a farce from the start.
    Lansley believed it would work, so mandated it to his inventions, the CCGs.
    Decent people then had a political imperative that it had to be introduced although they knew it was not fit for purpose.
    This is a political not a managerial failure, and Dame Babs is a politician not a clinician

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  • I'm afraid that 'Dame' Barbara Hakin has either little understanding of General Practice, or doesn't care.

    I have no confidence in her abilities.

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  • Round and round we go 're learning' that you cannot provide safe and effective OOH without clinical triage !!!

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  • Blame Lame *ame

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  • Harry Longman

    It's nearly two years since I wrote this piece in response to the omnishambles which was NHS111 launch. http://gpaccess.uk/evidence/nhs111-deep-reflection-the-redesign/
    That was after months arguing that it would be a disaster, as predicted by the SCHARR report. Truly, there ain't nothing like a Dame.

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