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'Struggling' NHS 111 puts pressure on GP out-of-hours services as calls soar

NHS 111 has struggled to cope with record call volumes over the holiday season, claims a group of GP out-of-hours providers, with one area forced to take back direct call handling as a result.

A survey of out-of-hours providers by Urgent Health UK, their representative body, also pointed to high rates of NHS 111 call abandonment by patients and delays in passing calls to the out-of-hours service.

Another provider questioned whether there were any clinicians supporting the 111 service for two days over the period.

This comes as national data revealed that NHS 111 experienced its highest-ever weekly number of calls at the end of December at 480,400 – up 21% on the week before.

But Dr Simon Abrams, chair of Urgent Health UK, the representative body for out-of-hours providers, told Pulse that NHS 111 operated ‘with frayed edges’ over Christmas and New Year.

He added that NHS 111 ‘has struggled’ over the bank holiday period, saying that the service ‘has obviously been working at absolute maximum capacity and sometimes going beyond’.

NHS England has built its integration programme for urgent care around NHS 111, including direct booking of GP appointments and ensuring one in three calls is assessed by a clinician.

Dr Abrams said: ‘All the services are meant to redirect patients to ring 111. GP practices put on their answering machines: If you need an out-of-hours GP ring 111. 

‘But one of our organisations said that was reverted back to ringing the out-of-hours service, so they obviously were not coping.'

Dr Abrams said that NHS 111 was still holding up but 'with frayed edges', and was headed for another ‘road bump’ in mid-January ‘when the people that contributed to getting everybody through the bank holidays, they are exhausted and they go on holiday or they go off sick and actually that’s quite a big test as well’.

Dr Abrams’s comments follow a survey conducted by Urgent Health UK of its members, which also revealed that one provider reported a 29% increase in activity.

The survey found that providers generally considered they were under considerable pressure ‘however there were times when workload became intense’. 

In a statement, UHUK said: ‘The Christmas and New Year break is a time when the percentage of general practice cover swings heavily over to the out-of-hours services. From Friday evening the 22 December to Tuesday morning the 2 January, in-hours provided 31.5 hours and the out-of-hours provided 229.5 hours.’ 

Out-of-hours services usually provide 115.5 hours of cover, while in-hours GPs provide 52.5 hours per week.

It comes as NHS England's latest update illustrated the pressure on A&E departments, with rising rates of bed occupancy alongside longer waits for ambulances outside hospitals.

It also come as Prime Minister Theresa May was today forced to apologise for the situation, having said yesterday that the NHS was 'better prepared' than ever before for winter, reports Sky News.

She said: 'I know it's difficult, I know it's frustrating, I know it's disappointing for people, and I apologise.'

Dr Chris Moulton, vice-president of the Royal College of Emergency Medicine, said: 'If this is better prepared, then it’s both a startling admission of the abject failure of planning in previous years and a poor reflection on the current plans.'

An NHS England spokesperson said: 'Actually NHS 111 services successfully managed 480,000 calls between Christmas and New Year, up by a massive 21% on the prior week, and its busiest week ever.

'In doing so, the data shows the 111 service successfully relieved pressure on GPs and out-of-hours services as well as hospitals. NHS 111 staff, like other frontline staff across the health service, deserve great thanks for what they're doing.'

This comes as Pulse revealed that commissioners are reserving a set proportion of GP appointments for NHS 111 direct booking following instruction from NHS England.

Meanwhile, out-of-hours services in Northern Ireland are buckling under the strain of winter pressures, including one trust reporting GP out-of-hours call back waiting times of 34 hours.

Readers' comments (6)

  • Nothing new here is there? If you have a service or business that is understaffed and underfunded then what do you expect. How the politicians wish that they could go back to the old system when us GPs were on call 24/7 for next to nothing. It’s time for the DOH to admit what can and cannot be done with the funds and workforce available but they won’t will they? And anyway those who have ‘flu shouldn’t be in a waiting room handing it on to the rest of the population!

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  • MORE agency for patient leads to more referral to gps. no one want to take risk. when you need doctors you need doctors. pharmacy, nhs111 or home care will not do.

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  • Please can we have some objectivity on this re.”flu epidemic”.Is there one currently?Figures suggest normal Winter season variation in respiratory and “flu-like” illness.Over the last 10 yrs or so this has been a great”smoking mirrors”strategy by Government spokespeople to deflect the Real A/E problem which is lack of hospital beds due to constant bed closures/numbers as part of NHS policy.If you combine this with their other convenient scapegoat-too many old people “blocking “the ever diminishing bed availability no amount of extra financial and staff resources in A/E will make the slightest difference.

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  • Vinci Ho

    I suppose the argument is always why do we need the ‘middle man’? We used to have NHS direct and now 111. The money to set that up and maintain should be injected directly to out of hour providers .GP-hating Cameron created 111 because it was meant to be ‘cheaper and better’ , with the bottom line of stripping resources from OOH GPs. Now it is a mess. Well , we have similar story with Capita.

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  • Is Hunt Going?
    Whether his departure would mean anything positive for GP land?
    Any thoughts on the odds and the repercussions.
    One thing I know - Education crises will deepen if he is put in that slot.

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  • 111. Is useless they stipulate the patient sees the GP within 2h for an URTI. Good point on why do we need the middle man. All the bureaucracy, GMC, CQC etc. If the patient does not like it they have the ability to sue. It will save us a lot of work.

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