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GPs go forth

NHS 111 putting 'disproportionate pressure' on GPs and A&E

NHS 111 is responsible for growing pressures on GP and A&E access because call handlers are having to default to the already overburdened services due to ‘limitations’ with the services on offer, GP and emergency care leaders have said.

GPC chair Dr Chaand Nagpaul told Pulse at a King’s Fund urgent and emergency care event on Tuesday that the algorithm used by call handlers too often ended with asking patients to attend the GP, and this was taking up appointments for other patients.

At the same event, Dr Clifford Mann, chair of the College of Emergency Medicine, said there had been a disproportionate increase in patients attending A&E after calling 111.

The helpline, introduced in April 2013, uses non-medically trained call handlers, who take the caller through a series of questions set by the computer algorithm.

Once they have determined the level of treatment needed, they will recommend actions based on what providers are available in the local ‘directory of services’.

However, Dr Mann told delegates that the lack of services available leads the call handlers to disproportionately recommend A&E or GP services.

Dr Mann said: ‘If you look at the proportion of dispositions who they recommend go to A&E or the numbers in which they’ve sent an ambulance directly, they’ve gone up disproportionately quickly.

‘We know that for every 1% change in the disposition advice NHS 111 gives, there’s a 6% change in the numbers of people who end up in emergency departments, whether under their own steam or by ambulance.

‘And the problem for them is that they go to the algorithm and look at the directory of services as to what’s available. And all too often, the only thing that’s available on the directory of services is the A&E department. So it’s not the fault of NHS 111.’

Dr Nagpaul told Pulse: ‘[GPs] are the victims of limitations in other parts of the system. With 111, whenever they say to a patient “go and see a GP”, which they do in large numbers, they’re not thinking about the impact that has on the GP service and the reduction therefore of appointments for other patients.

‘It’s because they’re only being measured on being able to respond in a certain amount of time and that’s their performance measurement.’

He added this was true across the system, saying: ‘There isn’t a thought about actually, have you managed that patient properly or have you just done your bit and then sent them back? So there are knock-on effects on general practice; it’s considered a bit like a sponge absorbing from the rest of the system, and picking up the pieces.’

Readers' comments (13)

  • When you ask a plumber to attend to someone having a stroke, what do you expect?

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  • yes, oh woe is me


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  • Bob Hodges

    Most of the time IT IS 111's fault however Dr Mann. On 2 separate occasions I have seen patients in OOH (diverted from the A&E or MIU that they had been sent to via ambulance by 111) with nothing more than a cold sore.
    The 2 times more often than i've seen '1a) Herpes Labialis' entered onto a death certificate.
    Delenda est NHS111.

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  • my ooh gp shifts on weekday evenings have become very quiet, eg not gone out in the car for the past 4 shits over the past 2w. unheard of. because 111 is diverting everything to miu, a&e or telling them to call an ambulance on the advice of a computer pathway.' sorry computer says 999' ' but little johnny is playing angry birds on his ipad, he not that bad, can't i just take him to see someone in a clinic' 'sorry computer says no' .a friend of mine is a local paramedic who has confirmed this is happening ie he has become very much busier since 111 took over. and of course the other reason i'm quiet is that patients aren't getting through or don't want to ring cos they'll end up with an ambulance at their door. its a joke, but i am getting a lot of pulse cpd modules done & what with my appraisal coming up thats quite handy..

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  • When I was a Nurse Advisor at NHS Direct (those were the days) I said that the day the computer started making the decisions was the day I would leave. I did my 111 training and realised that day had come. The pathway gave the disposition of A+E, but I knew I could give self care advice, I was told I had to follow what the computer said!

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  • No shit, Sherlock.
    If only someone had predicted this.......

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  • non-medical staff + risk averse algorithm = chaos in A+E .

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  • This comment has been moderated.

  • Shurleea Harding | Other healthcare professional | 17 December 2014 5:52pm

    Q- When you ask a plumber to attend to someone having a stroke, what do you expect?

    A- a 1970s adult movie?

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  • Any of our leaders wanting to know first hand information about " horrors" of 111, needs to speak to OOH doctors.

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  • The 111 service is a complete waste of money, the bottom line of every algorithm seems to be see contact a GP or go to A&E. I don't know how much the service costs but I am sure the money could be spent in a better way.

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