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NHS Alliance attacks 111 pilots’ ‘unachievable’ aims

By Lilian Anekwe

The NHS Alliance has questioned whether the implementation of the new national 111 number for urgent care will reduce non-elective hospital admissions, as it is set to be rolled out to thousands of patients in England.

The NHS Alliance paper, published this week, questions the business case for the implementation of the 111 number, which NHS managers hope will reduce use of emergency services and hospital admissions.

It is Government policy that a 111 service will exist across the country by April 2013, and Pulse has learned that as part of the expansion NHS North West will roll out the use of the 111 number across the region from September this year.

Several PCTs in the SHA, including NHS Blackburn with Darwen and NHS Central Lancashire, have identified the use of the 111 number for non-urgent emergency care as a key strategy in their plans to reduce hospital admissions – and in the case of NHS Blackburn with Darwen, to save nearly 20,000 non-elective admissions this year.

The NHS Alliance paper, published this week, says these targets are 'unlikely to be achievable' and called for a 'meaningful and engaging discussion' with GPs on the implementation of the 111 number.

'The Department of Health has created a service specification which is both exacting and all encompassing. Interestingly all of this is to be achieved within existing health budgets – there is no extra money.'

'If there is no new money, then implementing 111 requires a business case that stacks up.'

A Pulse investigation in January found early results from the 111 pilots showed as many as 85% of patients were referred to primary care. And the NHS Alliance warned the service was unlikely to achieve reductions in hospital admissions.

'Whilst we look forward to overwhelming evidence of a sharp reduction in 999 usage, and hospital admissions, from the existing pilot sites, early indicators do not support this outcome.'

'What has been designed, though laudable in its intentions, is a service that is unlikely to be achievable within local health economies and which will transfer responsibility and control of the gateway to "unscheduled" care outside of local health communities and into large-scale call centres.'

'With high anticipated call volumes it will produce a significant dent in any local health economy, which will need to be mitigated by significant reductions in unnecessary hospital conveyances via 999 and in hospital admissions.'

Instead the NHS Alliance called for a 'more localised version of the 111 service'.

The discussion paper was written by Dr Ray Montague, a GP in Bristol and director of the urgent care provider Brisdoc Healthcare Services.

He concluded: 'In its enthusiasm to solve all of the NHS' problems with access, the specification of the 111 project has outgrown its key objectives and risks derailing the preferred access routes into general practice, by reinventing a large-scale call centre solution that neither general practices or GP out-of-hours services are likely to be able to deliver.'

'A potential solution is to create a community based urgent care service that sits behind general practice, filling gaps that are revealed by a managed escalation in responsiveness and performance within practice based urgent care.'

Click here to download the full NHS Alliance paper

The 111 number aims to divert urgent care away from emergency departments Download a PDF about the new approach to '111'