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GP commissioners bemoan 'top-down' 111 rollout

GP commissioners are not being consulted on the development of NHS 111,  even thought they stand to inherit local contracts for the service from PCTs, a new survey reveals.

The survey of members of the NHS Alliance´s clinical commissioning federation showed clinical engagement with the service was poor and that commissioners felt the initiative was a top-down policy rather than local innovation.

Only 11% of commissioners said they had  experienced ‘good engagement' with their view taken into account', while 32% said there had been ‘some engagement, but no real ability to affect decision making' and 55% said there was little or no engagement.

Some 77% of respondents said that ‘there was little scope for local clinicians to shape this service to meet local needs'.

Only 4% said they would commission NHS 111 as currently specified.

The NHS Alliance suggested local CCGs should take more active leadership of the process for introducing 111. Those who felt ‘blocked' should speak out.

Rick Stern, NHS Alliance urgent care lead said: ‘We remain supportive of the idea and want to work in partnership with the Department of Health and other national partners to ensure that local commissioners are actively involved in the development of NHS 111.

‘However, our members currently feel disengaged and believe there is little room for local flexibility. We need to take steps to address this now, as otherwise both the 111 programme and the credibility of local clinical commissioning will suffer.  While there is support for NHS 111, in principle, there are substantial concerns about the speed and style of implementation.'

Dr Brian Gaffney, medical director for NHS Direct said: ‘The survey reflects significant concerns from GPs about the level of clinical engagement in developing and commissioning NHS 111 services. These concerns need to be taken seriously, not least because CCGs will inherit NHS 111 contracts and be responsible for the service in their local area.

‘GPs have highlighted there is ‘no real ability to affect decisions' and there is ‘little scope for local clinicians to shape this service to meet local needs'.  From our experience of leading four of the seven pilots, we know that local clinical engagement is imperative for NHS 111 to deliver benefits to local health economies.

Dr Gaffney added: ‘We know from our pilots that NHS 111 supports fewer patients to self-care than the 0845 4647 service, and refers more patients to face-to-face urgent care services. There is a danger of NHS 111 leading to substantial additional costs across the health system if it is not commissioned as part of the local urgent care services. The expertise for taking this forward lies with local clinicians and they need to be fully involved immediately.

'NHS 111 has the potential to improve access to urgent care and the actions proposed by the NHS Alliance need to happen very soon to influence the national roll out.'

A DH Spokesperson said: 'The NHS 111 services will bring significant benefits to patients and the majority of clinical commissioners are engaged with it. The pilots are enabling us to provide a basis for local design of solutions, and Clinical Commissioning Groups are already positive about how this will enable them to improve access to emergency and unscheduled care.

'We will ensure that although planning will go ahead for roll-out from April 2013, this will be achieved with CCGs in a leadership role.'

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