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GPs face fight for control of new 111 service



By Ian Quinn

GP commissioning groups are set to be plunged into battle with ambulance trusts and a skeleton NHS Direct service for control of the new 111 urgent care number.

The Government’s decision to scrap the NHS Direct telephone hotline – which Pulse has uncovered cost the NHS £123m this year – has been welcomed by the majority of GPs.

But both the ambulance service, which is spearheading the first pilot in NHS County Durham and NHS Darlington, and NHS Direct, set to run the next pilots in the East Midlands and East of England, will use fewer qualified nurses than NHS Direct does currently – and there are questions over how much say GPs will have in the running of the new service.

A Pulse investigation earlier this year revealed NHS Direct already sends 22% of its 14,000 calls a day to GPs as urgent or next day cases. And leading Labour MPs, including shadow health secretary Andy Burnham, claim the 111 service will see this rise.

Dr David Lloyd, founder and medical director of leading out-of-hours firm Harmoni, agrees and said he believed out-of-hours providers and GP commissioning groups would be far better placed to run 111.

‘The model [in the first pilots] looks like a pile of call handlers with relatively little medical input. A room full of call handlers and one nurse has the potential to ramp up GP workload by sending more patients to their GP.’

He added: ‘I think Harmoni would be very keen to run as much of the 111 service as was on offer. This would mean the people who are providing the out-of-hours service would also be in control of the 111 number which would make the most sense. GP commissioning groups could also be able to do it as part of their new role.’

GPC chair Dr Laurence Buckman also called for GPs to be far more involved in the future commissioning of urgent care services, warning of the dangers of call centres relying on algorithms to assess patients.

He said: ‘I can’t suggest that we’re sorry that NHS Direct is no more. We always believed it was a waste of money.’

‘Triage should be by doctors and nurses, not by lay people, not by using algorithms that are prone to error. This is an opportunity. There are three pilots going on at the moment, they will have to report and then I think we will have a better idea of what comes next.’

NHS Direct said this week it was forging ahead with its plans to slash the ratio of trained nurses, hoping the reduction in costs will help persuade the Government to give it the key role in running the 111 number.

NHS Direct chief executive Nick Chapman said: ‘The Government has not announced that NHS Direct as an organisation is being closed down. We expect to play a key role in taking the new service forward.’

Dr David Lloyd: new pilots more like a call centre than urgent care Dr David Lloyd: new pilots more like a call centre than urgent care