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Commissioners forced to retender contracts after NHS Direct hangs up on NHS 111

CCGs will be expected to put all NHS Direct’s remaining contracts for NHS 111 out for competitive tender after the provider announced it wanted to withdraw from all its contracts to run the urgent care phoneline as they were ‘financially unsustainable’.

In a major blow to the rollout of NHS 111, the company said it would seek a ‘managed transfer’ of all NHS Direct’s 111 services, and the frontline and other staff who currently provide them, to alternative providers.

As it tried to limit the damage from the pullout, NHS England said that the national rollout would continue and that although new providers may take over the service short-term, all long-term NHS Direct contracts would have to undergo a full competitive tendering process, despite opposition from the GPC.

NHS Direct said that it would continue to provide the service until alternative arrangements could be made by commissioners.

The provider already pulled out of two contracts in North Essex and Cornwall, and it is running a very limited service in its two biggest regions, the West Midlands and the North West after out-of-hours groups were required to take back responsibility of call handling.

In a statement released this morning, Nick Chapman, chief executive of NHS Direct, said that it would be seeking to divest itself of the remaining nine contracts it holds for NHS 111.

He said: ‘NHS Direct is seeking to withdraw from the NHS 111 contracts it entered into as these have proved to be financially unsustainable.

‘Whatever the outcome of the discussions on the future, patients will remain the central focus of our efforts, together with protecting our staff who work on NHS 111 to ensure that the service will continue to benefit from their skills and experience.’

A document leaked to Pulse earlier this year, written by the Deloitte consultancy firm, said that losing contracts in the North West and the West Midlands would ‘impact the overall viability of NHS Direct nationally’.

The review found the cost per call of over £20 for NHS Direct’s 0845 service was perceived as ‘too expensive’ and that commissioners responded to ‘strong pressure’ to find savings and that providing the service at the eventual figure of £7.50 to £8.50 per head of population was not tested sufficiently.

A spokesperson for NHS England said: ‘111 will be rolled out to the whole of England. NHS Direct pulling out of contracts will not affect this. It’s a Government commitment and it’s in the mandate between the DH and NHS England.’

Health minister Earl Howe told an emergency session of the House of Lords that NHS England will ‘recommission NHS Direct’s 111 contracts and will transfer staff who currently provide them to alternative providers. Patients should be reassured that they will continue to receive a high quality service when they call 111.’

Dame Barbara Hakin, chief executive of NHS England, said that ‘constructive discussions’ had already been held with potential new providers to take on these contracts, such as local ambulance trusts.

But Dr Chaand Nagpaul, chair of the GP, urged a new approach to tendering these contracts, saying the whole process had been an ‘abject failure’.

He said: ‘The Government must review its competitive tendering approach and instead look towards an integrated model based on cooperation between local services.’

This is the latest controversy to hit the troubled helpline, following severe problems with the rollout in some regions that led to out-of-hours providers having to take back control of triaging, a number of serious untoward incidents in its first months. A Pulse survey also revealed that only 8% of doctors think the triage process is safe.

Dr Amanda Doyle, chief clinical officer of Blackpool CCG, the lead commissioner for 111 in the North West, told Pulse that the service will not be live until this time next year.

She said: ‘We’re hoping that within 12 months we will have reprocured the service. We’ll be in a position to have a detailed service specification available pretty quickly.’

Dr Doyle, who is also the co-chair of the leadership group at NHS Clinical Commissioners, said commissioners would not be able to reject the rollout of 111 in their area. She said: ‘NHS 111 remains national policy. The problems we have had have mainly been about the provision. The principle remains the same.’