Exclusive: A Pulse investigation has uncovered a series of safety alerts across the Government’s NHS 111 pilots and concerns GP commissioners are being excluded from the rollout, which have prompted the GPC to demand the programme be put on hold.
Negotiators said they supported the principle of 111, but had ‘increasing concerns’ over its procurement and effect on patient care, and called on ministers to shelve the project until GPs had assumed full commissioning responsibility.
Information released by PCTs and NHS Direct reveals there have been nine serious untoward incidents across four of the seven 111 pilots, with patients needing urgent hospital treatment told to see their GP and an IT failure delaying dispatch of an ambulance.
Eight of the nine serious incidents occurred in pilots run by NHS Direct, which is being pushed by the Department of Health as the default provider of 111 across England.
In Luton – where 111 triages calls independently from the out-of-hours service – four incidents have been investigated, three of which saw patients told to contact their GP despite a ‘higher level of care being needed’. As a result, NHS Direct said ‘changes’ to ‘enhance questioning’ had been implemented.
The Lincolnshire pilot reported a similar incident and a confidentiality breach, and two incidents were reported at the Lancashire pilot run by NHS Direct with Fylde Coast Medical Services and North West Ambulance Services NHS Trust.
An NHS Direct spokesperson said the incidents had been reviewed as part of ‘continuous improvement’ and added: ‘We believe no patient harm came as a direct consequence.’
An investigation is also ongoing into an incident at a pilot run by GP out-of-hours provider Derbyshire Health United. NHS Derbyshire County said it could not comment until the investigation was complete.
Dr Peter Holden, GPC negotiator, said the incidents highlighted the risks of 111 directly triaging patients: ‘Triage should be done by the best-qualified person. Unless 111 is done by the service also responsible for delivering out-of-hours, it will generate work and demand. Some minister or policy wonk has got hold of 111 and is wrecking it.’
Pulse revealed before Christmas that several 111 pilots had been thrown into chaos after NHS managers were found to have breached procurement regulations.
Dr Holden said: ‘The time has come for us to say to Government, you should stop the reprocurement of out-of-hours services and telephone answering until clinical commissioning groups are in place.’
CCG leaders are complaining they have been bypassed by the rollout, due to cover the whole of England by April 2013. An NHS Alliance survey last week found only 4% of CCGs would commission 111 as specified.
Board papers published by NHS South East London this month show several CCGs have objections. Dr Adrian McLachlan, chair of Lambeth Clinical Commissioning Collaborative, ‘raised concerns on the national opt-in model’ and the ‘limited time to discuss options’.
Dr Peter Clowes, NHS 111 lead for Shropshire County CCG, was part of a delegation which met health minister Simon Burns over the issue last week: ‘Our out-of-hours provider Shropdoc’s clinical triage function will be taken over by 111. Even though it might be an improvement in other areas, it will probably reduce quality here.’
A DH spokesperson said it was ‘tracking’ GP engagement: ‘Any long-term decision must be made with CCG approval.’