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NHS 111 redirecting 'frequent fliers' back to GPs

Exclusive GPs are 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.

Pulse can reveal that GPs are being told to to contact patients who use the NHS 111 phone line frequently, after the service misinterpreted Department of Health rules on how to deal with ‘frequent fliers’.

DH guidance is that patients who call NHS 111 three times over four days should be assessed ‘to determine whether an ambulance is required’ and, if not, there has to be local agreements in place to make sure the patient ‘can speak to a GP within an hour’.

But Pulse has learnt that in some areas practices are being routinely told to follow-up patients if they phone the service more than four times, and that the GPC has been in talks with the Government to ensure the rules are applied correctly across the country.

This is the latest in a series of controversies to hit NHS 111, which is currently being rolled out across the country and will take over from NHS Direct on 1 April.

Official figures 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. The analysis of the pilots showed that they had ‘not delivered the expected benefits’ in terms of improving patient satisfaction or stemming the flow of patients being directed to emergency care and that they expected it to be more costly than current arrangements.

The GPC says NHS 111 is keen to avoid another Penny Campbell tragedy, in which a London woman died of septicemia despite calling an out-of-hours service eight times over one weekend in 2006, but that the way they are piling the responsibility on practices is ‘entirely inappropriate’.

Dr Peter Holden, a GPC negotiator, said: ‘What this amounts to is a license for those who can’t be bothered to make an appointment and get down to the surgery to jump the queue ahead of those who do. Because the rules say if you ring a certain number of times within a few days then you automatically get seen. It is entirely inappropriate. This is the NHS 111 trying to cover its arse, but that’s not my job.’

He told Pulse that the GPC was in negotiations with the DH, and that it had acknowledged there was a problem: ‘The DH understands it is for each 111 local commissioner to commission arrangements such that a frequent flyer can be triaged by a GP. It is not part of GMS and it is not to be just dumped upon GPs. They have to have a specific arrangement – a LES if you like. That piece of clarity is very useful.’

Dr Paul Roblin, the medical secretary of Berkshire, Buckinghamshire and Oxfordshire LMCs, confirmed NHS 111 had been burdening local practices in his area by placing an onus on them to contact every patient who rings the NHS 111 line more than four times.

He said: ‘They expected practices to phone the patient back within one hour. There is no way they can insist on that. We already already have mechanisms for patients who either themselves believe they should be attended to in one hour or who have been instructed to receive attention.’

Dr Andrea Jones, chair of Darlington CCG, one of the pilot areas for NHS 111, said the lack of a GP assessing referrals had been a major flaw.

She said: ‘There have been very similar problems with reported cases of inappropriate responses - either over response or conversely lack of appreciation of the severity of a patient’s condition.

‘The lack of clinician in the triage process is felt to be the main contributor to this situation. The pilot site has developed a sense of learned helplessness as despite clinicians complaining during and after implementation, the problems anecdotally appear to continue.’

A DH spokesperson said: ‘Whenever someone calls NHS 111, their care is of the utmost importance. Our guidance has always stated that if someone calls the service three times during a four day period they should be assessed to determine whether an ambulance is required and if not there has to be local agreements in place to make sure that person can speak to a GP within an hour.’

Pulse Live: 30 April - 1 May, Birmingham

Pulse Live

Dr David Carson, director of the Primary Care Foundation, will be talking about reducing emergency admissions at Pulse Live, which takes place between 30 April and 1 May in Birmingham.

Pulse Live offers practical advice on key clinical and practice business topics, as well as an opportunity to debate the future of the profession, and a top range of speakers includes NICE chair designate Professor David Haslam, GPC deputy chair Dr Richard Vautrey and the Rt Hon Stephen Dorrell MP, chair of the House of Commons health committee.

To find out more and book your place, please click here.

Readers' comments (20)

  • 111 will cripple the OOH service. In our area if you mention the word 'tight chest' on the phone as in ' oh hello I've had a nasty cough for 10 weeks and my test is a little tight I want a doctor to come to my house straight away' that will most likely take the person who has done their 2 weeks induction training down the ' potential heart attack tick box sheet' and they will call 999.

    The rate of blue light calls to ridiculous situations will escalate beyond belief.

    OOH sessions will become a nightmare and GPs will leave in droves.

    Along with imposed contracts, CQC, CCG and paycuts do you wonder why GP's are counting the days to retirement.

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  • What is this about? People need 24 hour access to primary care and hospital services.

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  • (At risk of an irate set of comments from my CCG who have heard my hobby horse too many times) , the basic issue that the NHS management are not adressing is that a substantive majority of frequent flyers have an expectation of professional input to their life for issues that are not appropiate for a health service to adress in any setting, shifting them to "less expensive" settings is not a cure for the "learned helplessness" behaviour.
    I am still waitig the NICE plan "Management of patients with inexplicable physical symptoms"

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  • 111 example from yesterday - 23 yr old asthmatic with exacerbation seeking advice was told he was having a heart attack, "dial 999 immediately" - he put the phone down on them and came to see us. More appropriate to see us, but you worry about this system and the effect on the service if that is the guidance being given. Apparently he was quoted " the computer is telling me you are having a heart attack". Disasters waiting to happen I fear.

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  • Vinci Ho

    So another example of fragmentation of personality as far as DoH and government are concerned. The Chamcellor is to deliver a hopelessly tight budget today and this 111 is costing 5% more in ambulance attendance in these pilot areas. Where is the logics?
    Once again ,DoH is totally remote and obsessesd with constant reorganisation as per Lord Francis.
    Do not forget GPs time is inappropriately consumed to catch up with these 111 'referrals' , hencing jeopardising the best interests of other patients .
    Duty of condour? Seriously ? Who is listening to us???

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  • What is this about? Its about ensuring that people who use services appropriately are not disadvantaged by those whose usage rate needs to be managed down to levels appropriate to their condition. Anybody who is assessed as needing a GP contact within 1 hour needs an emergency service response. Those who need a response within 2-4 hours are prime GP and primary care clients. What people need and what they want are not usually closely related

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  • Tom Caldwell

    The analysis of the pilots showed that they had ‘not delivered the expected benefits’ in terms of improving patient satisfaction or stemming the flow of patients being directed to emergency care and that they expected it to be more costly than current arrangements................ so in keeping with government policy they will push forwards with something costly and crap and pandering to those who make the most fuss.

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  • I beleive that the 111 service is a good idea and it seems that all the complaints are really directed at either the process or the inibility of the call centre staff to use some common sence (maybe they're not allowed to!). No doubt the computer program that tells them a patient is having a heart attack was written by the usual idealistic computer programmer for whom everything is black and white and for whom the phrase "what if" does not existy. I would have thought that with proper management and collaborative working the 111 service could be an asset and ultimately generat savings.

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  • two cynical thoughts come to mind
    if you pay peanuts you get monkeys
    and GIGO, garbage in, garbage out

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  • Anonymous @9.35,

    The problem is that it's very difficult for a computer program to distinguish between a heart attack / asthma attack / GORD etc. It's hard enough for a clinician with 10 yrs experience. Asking untrained operators to do this with an inflexible computer program is doomed to failure, and will never work. Sorry, but there are some things in life which just can't be dumbed down.

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