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CAMHS won't see you now

NHS 111 can save general practice

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I have a guilty secret. I actually think NHS 111 is a really excellent idea, and we need to work hard at saving it.

I know, plenty of you lovely Pulse readers will think I’m crazy but I find myself strangely passionate about this issue. I realise Dr Mark Spencer has already given his ideas, but I think we need to broaden the discussion. Too much of the debate about NHS 111 has been regarding urgent and emergency care. We need to take a step back and think about what NHS 111’s fundamental purpose is, and I think limiting its purpose to triage is a missed opportunity.

Imagine, if instead of each surgery having its own phone number, all patients had to ring 111 first

Let’s think about its number one strength: it’s an easily remembered phone number, which most people now know can get them help with their health. The NHS is a sprawling behemoth of an organisation. I can hardly navigate it, and I’ve been studying in it or working in it for 15 years. How is your average patient meant to navigate it?

Now, let’s think about the number one difficulty facing general practice: if a patient rings up, our organisations are set up to deal with it, whatever it is. I’ve already written about why I think we need to give up the gatekeeping role of general practice and I see NHS 111 as the ideal tonic to save general practice.

At the moment, individual surgeries are purchasing web-based triage tools for their surgeries in the vain hope that it’ll reduce demand. But if NHS 111 was expanded with better algorithms, then this could divert a significant volume of calls away from our besieged reception teams and appointments to more appropriate providers. Imagine, if instead of each surgery having its own phone number, all patients had to ring 111 first.

111 could direct a patient with an ingrown toenail straight to the podiatrist. They could direct a patient with a painful back injury straight to a physiotherapist. If a patient had a query about side effects of a medication, they could be directed to a pharmacist first. 111 could give simple self care advice to patients who don’t need to be seen by anyone. Of course, they could even divert those likely broken limbs direct to minor injury units or A&Es if appropriate. They could direct administrative queries about hospital appointments directly to the hospital secretaries so that our administrative teams’ workload is eased.

Why is every GP surgery across the country developing or buying in their own triage and telephone advice service when we have one sitting there waiting to be used? I think we need to be brave. I think we need to look to a future where 111 is the single phone number of the health service.

Dr Phil Williams is a First5 GP in Lincoln, and former RCGP National Lead for the First5 initiative 

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Readers' comments (16)

  • AND we could outsource it to India!
    And we could ensure that no one at the call centre really understands the skills mix of the professionals on site so they book ear syringes with the GP and complex mental health reviews with the HCA.
    AND we could dramatically increase indemnity costs as we get it wrong more.
    AND we could loose all the continuity with a local health service who know and understand the million shades of misery that make up the human condition and enable them to deliver personalised, high quality scalable and affordable care to the population.
    AND we could f*ck up the most cost effective health system in the world.


    How about no.

    Why don't we consider a model that puts humans at the centre, rather than making them an inconvenience - not just the humans who get it done to them (FFS) but those who refuse to do it to them, but work with them.
    Why don't we think about empowering people to care, rather than shackling them with technology that gets in the way of that.

    You're so last-century-big-corporate-little-dream-no-idea-of-how-it-will-really-work-in-the-real-world. Successful big companies use data well, but they use human beings far better, and corporate off-shore call centres are being replaced.


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  • Isn't what you're describing NHS Direct? The predecessor to 111 which was dismantled for being too expensive due to actually having clinicians.

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  • actually I think it is an interesting idea.
    this is all about managing expectations.
    there is a well known phenomenon when availability of treatment/investigation feeds demand.
    in this case, I agree, it does not need to be a fully trained GP who will advise a customer on how to fill in a self referral form for podiatrist for their sore toe. remove GP- and customer will learn how to find podiatrist themselves. Remove the podiatrist- and, OMG!- they may begin to self care.
    all I'm saying is that the system that does not encourage dependence on HCP is far preferable to one that does. I have seen too many punters who's main problem really is learned helplessness and we shouldn't be encouraging any more of this.

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  • 111 with medically qualified staff. Workable but too expensive . Anything else is a waste of money because it's not fit for purpose .

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  • Deluded rubbish

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  • Actually yes I do kind of think you are crazy
    Clear overwhelming evidence has shown 111 to be a catastrophic failure

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  • 'Direct a painful back injury to a physiotherapist' - who would do what exactly, except send them to us for analgesics.

    Ditto podiatry.

    Ditto the pharmacist.

    Oh and I've done all this in one 10 minute appointment.

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  • If one had to pay the market rate for healthcare then such a service would be useful, as it would help patients decide who to see. They would be incentivised to see the physio or chiropodist as they would be cheaper than a trained experience medical professional. And if they wanted to see a GP regardless the payment would help sustain such a system.

    But, unlike food, GPs must be free in our wonderful NHS so are, predictably, the path of least resistance.

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  • This is how the Swedish health care system works....but..... the Swedish health care system is now in a worse state than ours.

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  • Why am I not connecting with smiley GPs wearing glasses?

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