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DH’s 111 number to swamp GPs

By Lilian Anekwe

Exclusive: GPs face being swamped with extra work when the new 111 urgent care number is rolled out across the country, after early results from pilots showed as many as four out of five patients are being funnelled straight to primary care.

Preliminary findings from an evaluation of the first pilot of a single urgent care number in County Durham and Darlington show that 85% of callers were referred to primary care – in most cases to practices and in a few to urgent care centres, nurse-led services or pharmacists.

In two further pilots, just over half of callers were told to see their GP. The alarming figures suggest more than twice as many patients will be handed on to GP practices as are currently referred by NHS Direct, which sends around 22% of callers to see their GP.

Dr Agnelo Fernandes, the RCGP's clinical champion for urgent and emergency care and a member of the DH Urgent and Emergency Care Governance Board, said: ‘It depends on the nature of the call and the time of day, but 85% is significantly higher than would be expected.'

Four pilots of the 111 scheme were launched last year, with the Department of Health announcing in December that it would be rolled out across the country by the end of 2012.

But a preliminary evaluation conducted by the University of Durham shows in the north-east pilot, run by the North East Ambulance Service NHS Trust, ‘the bulk' of calls were directed to primary care.

Dr Katherine Noble, clinical lead for the NHS County Durham and Darlington pilot and a GPSI in urgent care in Chester-le-Street, County Durham, told Pulse: ‘Referral to A&E is around 2%, which is nice and low. But something like 85% of calls have a primary care disposal. There is some reticence to buy in among local GPs but I think that's only right. There are some who are hostile, but it's the minority.'

But Dr Noble denied the referral rate would cause a surge in GP workload. ‘The 85% is a big number but not all of that proportion will see their GP. What the patient are advised and what they do may be different things.'

Meanwhile, an analysis of just under 2,000 calls made to the 111 service in the Lincolnshire and Nottinghamshire pilots found that 55% of patients were referred back to see their GP. An average of 13% were told to see their GP within two hours, 24% were told to attend that same day and 19% were told to make a routine GP appointment.

Dr Ruth Livingstone, the clinical lead for the pilot running in Nottingham and Lincolnshire and a GP in Stamford, Lincolnshire, said: ‘We have statistics people working on data and comparing them with a number of past years. You need to compare it to background years and see if it is reduced the increase rather than the overall number.'

Dr Ian Trimble, chair of the professional executive committee at NHS Nottingham City, said: ‘It's very early days, but my concern is that the algorithms are risk averse and will increase the recourse to getting patients to see a clinician when perhaps they don't need to.'

But Dr Greg Place, chair of Nottinghamshire LMC, welcomed the scheme: ‘I'm not looking for the 111 service to reduce our workload necessarily, but to reduce it elsewhere. It might be extra work, but we should not shy away from it.'

Dr Katherine Nobel Pilot findings

County Durham and Darlington:
85% of calls referred to primary care
2% referred to A&E

Nottinghamshire and Lincolnshire:
55% of calls referred to general practice
6% referred to A&E

Source: DH preliminary pilot findings