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NHS 111 sending rising number of patients to A&E

NHS 111 is referring a higher proportion of callers to A&E and ambulances compared with three years ago, an analysis has found.

Health think-tank the Nuffield Trust looked at NHS England winter operational data, finding that since NHS 111 replaced NHS Direct across England in 2013 the number of callers to the non-emergency number passed onto ambulance services or A&E departments rose by 3% – from around 150,000 a month to over 200,000.

The analysis found that primary care remained ‘the main destination for 111 callers’, with call handlers referring around 60% onto primary care services.

But the think-tank also found that NHS 111 significantly reduces pressure on primary and urgenct care services.

A survey of NHS 111 callers, carried out by NHS England, found that just over a third would have gone to primary and community services if NHS 111 was not available, and 45% would have gone to A&E. But NHS 111 data showed call handlers send on only a fifth of callers to other NHS services.

The news comes as Pulse has reported that GPs find that only one in four referrals from NHS 111 is clinically appropriate.

The report said the number of referrals to emergency services has increased as more people use the service and suggested that the rising proportion sent to A&E is because NHS 111 ‘is in fact meeting patients’ needs better’.

Pulse previously reported that NHS 111 was told to have GPs available at peak times to give clinical advice after it was piloted in eight call centers across England, with the aim of increasing clinical input in the calls.

But GP leaders still said the service should be scrapped, saying that non-medically trained call handlers should not be advising patients.

A BMA spokesperson said: ‘It is important that NHS 111 has recognised that a greater proportion of calls must be handled with the support of clinicians rather than just lay call handlers who often refer patients to the wrong service.

‘This key flaw has over the years added to the pressure on already overwhelmed GP services which are still seeing far too many unnecessary cases passed to them as this report demonstrates.’

They added that the GPC will be ‘pressing’ NHS 111 to deliver on promises to integrate clinicians from local urgent care services into NHS 111 ‘so that calls can be assessed properly without the need to direct people to A&E or GPs’.

Jonathan Ashworth MP, Labour’s shadow health secretary, said the figures are ‘further evidence’ that the winter pressures in A&E this year ‘are the result of a catalogue of bad choices by the Government’. 

He said: ‘The decision to scrap NHS Direct and replace it with the NHS 111 was strongly criticised by health professionals, and today we have learned that NHS 111 is sending more callers, and a higher proportion, to A&E than in previous years, with great variations in performance across different regions.’