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Call centres’ triage tools to blame for failings of NHS 111

The lack of GP input into the call centre is having a detrimental effect (‘Analysis: NHS 111 debacle piles pressure on GPs’). More calls are going to GP out-of-hours services, leading to a necessity to speak to a GP.

Expected savings in the out-of-hours service are not going to be realised if NHS 111 has to retain this triage component.

If they continue to use the same tools, then the urgent care system in each area will not be robust enough to cope with whatever the call centre sends out.

From Dr Ashok Vora, West Heath, Birmingham

Readers' comments (9)

  • NHS Pathways is the triage software used in 111 and should be stopped. NHS Direct have been safely using another software programme for triage for over 12 years with safe outcomes. Triage should be performed by nurses, non clincal staff in this environment do not have the skills to safely assess the public.

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  • NHS Direct worked extremely well and safely for 14 years, however, 'the powers that be' deemed it was too expensive at £24 a call! As usual governments not looking further than the next election decided they needed to save money and bring the cost of the calls down. In this case Labour! Hail the beginning of the 111 service. The plan.. for calls to be dealt with a top heavy proportion of non-clinical call handlers. Thereby passing less calls through to drastically reduced numbers of experienced senior nurses.
    With NHSD the majority of these calls were given advice about how to manage symptoms at home with specific worsening instructions, so the caller was in doubt about what to do should their condition change.
    So now we have the 111 service being managed by over 40 different organisations both NHS and private organisations, where once we had one national organisation managing we now have over 40! Non clinical staff have high dispositions due to lack of knowledge and as we know face to face consultations cost a lot more than £24!
    Shortsighted governments that don't look at the bigger picture and unqualified ideas and decisions that in this case has cost the country dear. It is not NHSD at fault here!

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  • Place £24 per telephone call in the light of OPD attendances £130+ it looks cheap- place it beside the cost of a face to face premises based primary care consult £19 and it is more expensive.
    What source did anonymous 11:19 use to obtain figures as it looks like they may not have included primary care GP in the comparison.
    This is flat cash cost- the "worth" of a service is did it close the patients health need fully at first contact?" Only 24% of NHSD/111 does-
    mainly "where is my chemist"
    or"where is the STD clinic"-
    commercial directory enquiries handle these type of requests for under £3-00

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  • 2 reports from 111 today - first 8 minute ambulance called for patient with chronic diarrhoea, second advised to see GP within 2 hours - fortunately relative ignored advice and called 999 but patient died in A&E

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  • Why not revert to previous system before Labour's Hewlett fouled things up on both cost and efficacy? Cost cutting should be pursued - eg reduction in admin/management employees of the NHS and an awareness that the enormous immigration permitted by both Governments must surely contribute to available funds for running the NHS albeit more efficiently.

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  • Patients have to do their own triage: Call 111 unless it is a medical emergency, in which case call 999. When do we get the training?

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  • @Anonymous | 27 June 2013 10:11pm
    To support your claim of "... that the enormous immigration permitted by both Governments must surely contribute to available funds for running the NHS albeit more efficiently." please kindly supply evidence backed by reliable figures.

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  • The NHS Pathways should have been written by people with vast out of houres experience, people at the coalface, not by academics with university hospital knowledge only

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  • I wonder if the letter writer is not aware of the full data here. Although an imperfect system, in need of some tweaking, in areas where NHS 111 is completely live - i.e. where OOH calls were not repatriated to the local OOH service (admittedly small pockets nationally), it appears that there has been a reduction in activity at OOH with no reflective upsurge of activity in A&E. In addition, ambulance conveyance rates for 111 calls are currently at a higher percentage, in my area, than for 999, meaning that NHS Pathways offers a more accurate assessment of when a patient needs immediate attention, than the current system used by our local ambulance trust.

    It is very easy to be negative here, but it is more worthwhile to identify what works well, and what requires improvement: don't throw the baby out with the bathwater Dr Vora.

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