The GPC first started hearing from GPs concerned about the new NHS 111 urgent care number last summer. Just as we do with any of the issues our members come to us about, we took it up with the Government – checking the facts, offering constructive criticism and, where possible, making sure immediate practical problems were resolved.
Slowly, the trickle of reports became a flood – NHS 111, a system we agree with in principle, was clearly causing a lot of concern. Broadly, the feedback we received fell into five areas.
There were those who were generally concerned about the impact of NHS 111. Having seen what had happened with NHS Direct and NHS 24 in Scotland, where overly risk-averse call handling has led to increased demand for healthcare services and higher referral rates, GPs were worried about the potential cost to the NHS at a time of huge financial constraint.
There were those who didn't like the concept of a single triage system, because doctors, as our medical defence organisations always tell us, should not rely on information elicited by others.
Others were worried about the effect on the services for which they worked, particularly out-of-hours providers.
Already stretched, these services wanted to make sure the transitional arrangements would be handled well given the potential for service destabilisation – particularly if, as with NHS 24, NHS 111 failed to cope with demand and they hadto step in. Many were very concerned about what this would mean for patient safety.
Then there were those who were involved in the nascent clinical commissioning groups, the very people the Government wants to make sure are involved with all procurement decisions, reporting that they felt excluded from the process and were worried they would inherit costly, ill-conceived and unalterable arrangements for their local area.
Finally, there were what some might consider the more niche concerns. What, for example, would be the impact on patients living just across a national border during the changeover – those who accessed English services because they were closer to where they lived? Niche perhaps, but certainly valid and just the sort of concern that the GPC picks up on all the time when it comes to new Government policies.
Learning the lessons
I've lost count of the number of times policies filter down from the centre, often without enough thought having been given to how they will affect different parts of the country, particularly in more rural areas.
When we went public with our concerns we knew others agreed with us, but I was still surprised to see how many organisations came right out and said so. The NHS Alliance had already made its feelings known, but it was joined by the NHS Confederation, the Royal College of Nursing and NHS Direct, all echoing our call for a delay to the implementation deadline.
That deadline remains at the heart of the problem.
Procurement decisions are being recklessly rushed through in order to ensure full rollout is achieved by April 2013.
An extension would allow CCGs to become more fully established and drive local procurement decisions at a pace that would enable the right decisions to be reached.
Crucially, it would also give them the chance to see the evaluation of the pilots. Yet again, here's a typical Government mistake – and all governments have made it. Pilots are set up, with a huge amount of work going into them, but then no time is allowed for any lessons to actually be learned. It's as if nobody really wanted to see the answers.
As Pulse has already highlighted, there have been problems with these pilots, including a number of serious untoward incidents, so learning is going to be crucial if NHS 111 is actually going to become a good service.
The Government has said it is ‘considering' our concerns but, as yet, has said no more. If it wants to ensure NHS 111 works in the way it intends it to, it would do well to slow down – not something any politician ever likes to do.
It would be a shameful waste to ignore the emerging evidence and for ministers not to do everything they can to ensure the NHS gets a cost-effective clinical service that is safe for patients.
Dr Laurence Buckman is GPC chair and a GP in Finchley, north London
