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Let GPs decide if NHS Direct lives or dies

It looks like 111 is here to stay - but GPs must be handed control of how the number is introduced

NHS Direct is the service that will not die, much as many GPs might wish it would. When the Government announced back in August 2010 that NHS Direct was to be scrapped, the response from GPs was generally of delight – the service having long been a bugbear of the profession for its tendency to send waves of minor illness to practices for no readily apparent reason.

Then health secretary Andrew Lansley, in the face of a media backlash, suggested NHS Direct might not be for the chop after all, and just a few months later it was placed in charge of three of the first four first-wave pilots for the new NHS 111 number.

But Pulse this week uncovers evidence that all is not well at those pilots. In Luton, NHS Direct has been forced to alter its policy on how calls are processed after four serious untoward incidents involving the 111 number, three of which concerned patients being sent to their GP when they needed hospital care. Two further serious incidents occurred at a pilot in Lincolnshire and two in Lancashire. Senior GPs have told of their concern at the way some 111 pilots have been procured and questioned whether organisations like NHS Direct should be triaging patients themselves, rather than working with the local out-of-hours provider to direct patients to the best service.

That patients need directing is a problem entirely of the Government's own making. In the days when urgent care was provided by a mix of GP practices, out-of-hours services and A&E, patients knew where to go, but that's no longer the case in the bewildering new world of walk-in, Darzi and urgent care centres. NHS 111 must have seemed a nice, neat solution – a single number for all patients' urgent care needs – but when the health service needs to make £20bn in efficiency savings, it can't necessarily afford nice and neat. Doctors' leaders are increasingly asking whether the number is needed. An NHS Alliance survey found only 4% of GP commissioners would run the service if they had a choice.

But GP commissioners don't have a choice – not about whether to run the number, and often not even over who should run it. Across London, GPs have been told they must either hold an expensive full tender or accept NHS Direct as the ‘default' option. It is ridiculous that at a time when GPs are supposed to be taking the lead on many aspects of the health service, they have had so little say in how 111 is delivered, how it processes calls, and how it links up with practices and out-of-hours services. It is those concerns that have rightly prompted the GPC to call for a one-year pause in the procurement.

Realistically, 111 is here to stay – the Government has invested political capital in it, and arguably has a rationale for introducing it. But GPs must be handed control of how the number is introduced, and whether NHS Direct lives or dies.

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