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A faulty production line

'NHS 111 will improve patient safety'

The rollout of NHS 111 has been pretty smooth, despite issues in some areas, says Dr Agnelo Fernandes, the RCGP’s lead for urgent care

The rollout of NHS 111 is going on fine where the local implementation plan is actively managed and on course - in other words, where the providers are working with commissioners to ensure there are the right staffing levels and the right levels of training and so on are in place.

The decommissioning of the 0845 NHS Direct number will also result in an increased call volume to NHS 111 which needs to be anticipated and planned for. Where testing has shown that NHS 111 service is not yet ready - for example with appropriate levels of trained staff - it is only sensible that go-live is delayed with safe contingencies in place.

The whole of London is successfully covered by NHS 111 now, except for the one area in southeast London where the model is not in full operation, so it is unfair to call it ‘chaos’. Every area has a local NHS 111 clinical governance group led by a local GP that oversees the safe and effective development of NHS 111 in their area.

The staff training for NHS 111 is very robust – you can’t get anyone to answer the phone and carry out an assessment, you need appropriate numbers of properly trained staff.

Three things are happening at the same time. NHS 111 is being developed as the 0845 NHS Direct call volumes fall as it is decommissioned and front-end call-taking from GP out-of-hours services transfers to NHS 111. Pilot data from around the country shows that NHS 111 hasn’t increased A&E attendance, nor has it impacted on daytime general practice. The total call volume to GP out-of-hours services has reduced significantly, and the acuity of the case mix seen as a proportion increased as would be expected.

Data has shown that ambulance call out rates have gone up marginally; however, this now includes callers who would have been referred directly to the ambulance service by NHS Direct and GP out-of-hours services as these services merge with NHS 111 for call handling. When the NHS 111 service starts, the training of the staff means they are more risk averse than when they get experience.

But what is being found, especially in London, is that of those who are referred to the ambulance service, a high proportion of them – around 82% of red calls - are conveyed to hospital, suggesting that these are sick people that require this response anyway, meaning it is working. It is picking up what it should pick up. It is a learning curve for call handlers and as the service becomes more mature and they get used to doing it, then ambulance call outs become less.

It will not endanger patient safety – on the contrary, people that should be going to hospital early are being picked up by the ambulance service, and more importantly, getting there quickly, so there are no delays in ringing the patient back. With NHS 111 you get through and get advice on the phone, with the aim of patients getting the right care first time.

All local GP commissioners of NHS 111 services have chosen to use NHS Pathways. NHS Pathways is a suite of clinical content used by the call handlers and is designed to be clinically appropriate for the NHS, consistent and evidence based. It is governed by a group made up of representatives of the medical royal colleges. So it is not relying on an individual call handler or a clinician’s knowledge about local services but supports their decision making. NHS Pathways is designed so that non-clinicans can be trained appropriately to safely come out with the appropriate outcome to direct callers to the most appropriate level of care using a local directory of services determined by local commissioners.

It is too early to say whether NHS 111 is successful or not as it is only just being rolled out as the NHS Direct 0845 number is decommissioned. However, as a single point of contact with an easy-to-remember number for patients, it is a model that is safe using an evidence-based suite of clinical content and access to a local directory of services. It is an invaluable tool for commissioners to help design their services locally, as well as making better use of a nurse and GP workforce that is in short supply. The concept of NHS 111 offers opportunities.

Dr Agnelo Fernandes is the RCGP’s urgent care lead and a GP in Croydon.

Readers' comments (11)

  • Really sad to see how a national scandal has been reduced to 'issues in some areas'. Cherry picking of and manipulation of statistics is not the way to answer what many of us knew was going to happen.
    I realise Dr Fernandes is a fervent believer in NHS 111 but even fanatics need to see beyond faith and admit to the truth.
    How it has been set up is a second rate way of helping patients and I would have expected the RCGP lead to accept that.

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  • Looking at his article I'm sure he is writing about his dream of 111 working but most certainly not the reality.
    Supposedly things are fine, apart from 'some issues in some areas.' How about so many issues in the whole of the North West and the Midlands that the Out of Hours providers in these entire 2 areas have already taken back all the calls from 111 because the new provider couldn't handle the activity levels, despite the public not knowing about the service as a gagging order has been put on all helathcare professionals until the official launce in April!!. This handing back of calls is potentially for the next month!! Put into context, this wasn't based on a Saturday morning, or even a Bank Holiday, this was a Thursday evening, probably the quietest night of the week in the OOH arena!
    Supposedly 111 works if the provider and commissioner are working together to ensure correct staffing levels. In the North West, the commissioners have been repeatedly assured that the 111 provider is ready and has enough trained staff. 45-90 minute waits for a call 'to be answered' as soon as the service goes live suggests otherwise to us mere mortals. Please take note Dr Fernandes as this is reality!!
    The other reality, that unfortunately none of us are aware of as yet, is that what if there was some poorly patient calling with a life threatening condition at the time of go-live on Thursday evening? Normally they would have been answered within 60 seconds and assessed within 3 minutes. This was in the old regime of OOH providers. Unfortunatley we may never know as a wait of 45-90 minutes may have been their last!!
    Will this 'small issue' ever be blamed on a poorly thought out service that replaced a perfectly well working one of OOH providers? Unfortunately I feel, if Dr Fernandes and his other cronies have there way, then this will be another slight on OOH provision.
    Staff have lost their jobs and patients have lost quality healthcare provision, all for the idea of someone who obviously has no clue what they are doing in designing this new service!
    Dr Fernandes, look outside of your little bubble and take a look at the 'small issues' that are happening in the real world rather than just your own.

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  • What a travesty of an article. Our out of hours provider ranked as one of the best in the country has just had to take back all the primary triage at the 'soft' roll out because of the chaos and lack of service. THE PILOTS WERE A DISASTER - SOMEONE SHOULD LOSE THEIR JOB AND REAL ACCOUNTABILITY SHOWN FOR THIS WASTE OF RESOURCES - please all practices write to their MPs demanding debate and action

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  • What planet did Dr Fernandes qualify on?

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  • Does this chap live on Planet Zog? Is this the official response of the RCGP or just him in his own fantasy land?

    We should be told.

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  • T Roscoe

    When did using unqualified laity for medical triage improve patient safety?

    When did delaying access to health care for several mhours due to lack of capacity help patients?

    He should resign

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  • What a shame that so many highly experienced nurses have been made redundant from GP out of hours services with the move of contracts purely based on cost and not quality of care. All the problems in the area that I worked in were anticipated.

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  • I believe Dr Fernandes heads the clinical board for NHS Pathways / NHS 111 - surely this is a conflict of interest that ought to be declared in such an article

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  • Poppycock and tosh!!!

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  • I work as a Gp in urgent care. I have had patient attend whohave phoned 111 as their babys temperature was in the 36 celcius range. 111 have advised some of these patients to go straight ot UCC/casualty. With this level of training for 111 staff the only result will be 999 and ED/UCC departments being overloaded. Thanks for nothing 111

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