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GP appointments to be reserved for NHS 111 direct bookings under national scheme



Exclusive Commissioners are reserving a set proportion of GP appointments for NHS 111 direct booking following instruction from NHS England, Pulse has learned.

Under the NHS England instructions, at least 5% of all callers must be given the option of booking an in-hours GP appointment following contact with an NHS 111 clinician, if a GP appointment is deemed to be necessary.

CCGs have told Pulse that they have been asked to meet the 5% target by December 2017, with the target growing to 30% by April 2019.

NHS England has not confirmed how the target will be enforced, or whether there is any money attached to it, but it follows pilots elsewhere in the country that were set up to further NHS England’s ‘integrated urgent care’ policy.

But GPs say there is still ‘skepticism’ over how NHS 111 direct booking to in-hours GP appointments will effect workload and any target will have to be included in this year’s GP contract if it is to succeed.

NHS Windsor, Ascot and Maidenhead CCG told Pulse that rolling out NHS 111 direct booking has been made a national target set by NHS England.

A spokesperson said: ‘All CCGs are required by NHS England to have at least 5% of booking from NHS 111 into an in hours GP appointment by December 2017 and ultimately 30% by April 2019.’

Further explanation from the CCG revealed that ‘5% of all callers will have the option to book an in hours GP appointment following a contact with NHS 111 if a GP appointment is the most appropriate onward pathway’.

NHS England would not comment directly on the details of the national target, but responding to Pulse’s inquiry, a spokesperson said: ‘For those patients who call 111 and are assessed by a clinician (not just by a call handler) as needing a GP practice appointment it makes sense to be able to book that directly.

‘The ability of a 111 GP, nurse or paramedic to accurately assess whether a person needs a practice appointment is likely to compare well with the alternative of an equivalent judgement having to be made by the practice’s own receptionist, especially if this then occurs some time later when the patient may already have just decided to head to A&E.’

But Dr Nigel Watson, chief executive of Wessex LMCs, said that GPs are ‘wary’ about opening appointments to direct booking.

He said: ‘We’re short of appointments now and struggle to meet the demands, so the thought of just opening it up to another provider to directly book is not something at this stage that we would agree locally, I think it’s got to be a nationally negotiated agreement.’

He added that GPs are unlikely to open up their appointments as ‘there is nothing in my contract to allow direct booking’.

And Dr Simon Abrams, chair of Urgent Health UK, said: ‘There remains a lot of skepticism about how that’s going to work.’ 

He said the concern is largely around ‘holding sessions or appointments open to enable 111 to book, both in terms of being able to cope with the extra work and also the risk of the losing appointment slots if they’re not needed’.

However, he added that direct booking ‘does seem essential, it does seem part of making the service work for patients’.

NHS England launched a NHS 111 direct-booking pilot last year in the North-East of England but Pulse reported soon after the launch that NHS 111 call handlers were slow to fill appointments

Newcastle and North Tyneside LMC chief executive Dr George Rae has now told Pulse that only 25% of appointments reserved for NHS 111 are booked, with the rest going unfilled.

He said: ‘If my partnership is a reflection on the other partnerships – and normally that is the case – it’s not inordinately used but there is an availability there. 

‘We do, in our partnership, have three appointments per day and there is days when they are filled but there are days when they’re not filled.’

He added that the 25% fill rate has meant the workload is manageable but he said ‘the point is that if we reach the point where they are being filled all the time then it might be a different answer’. 

NHS 111: a history

NHS 111, when launched in 2013, first replaced nurses with lay call handlers who follow a series of pre-programmed questions to triage patients and recommend a disposition. Former GPC chair Dr Chaand Nagpaul had criticised the scheme for ‘disproportionately’ recommending patients go to their GP adding unnecessarily to practice workload.

Then as part of an NHS England bid to mitigate winter pressures in 2015, NHS 111 providers were told to recruit GPs to give advice to call handlers at peak times and boost the input from clinically trained professionals.

Matthew Swindells, NHS England’s director for operations, information and growth, later said that 80% of patients who would have been sent to the GP under NHS 111 guidelines could have avoided the visit if it was a GP that took their call.

This came as NHS England announced in March that one in three calls to NHS 111 will be assessed by a clinician under plans to ‘beef up’ the helpline.