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How GPs are using 111 to redesign urgent care

Dr Ruth Livingstone explains how GPs are using the new NHS 111 number to redesign urgent care services.

Put any group of GPs together to talk about resources, and one of the issues we agonise over is the inexorable rise in patients with trivial problems using the ambulance and A&E services, and the resulting impact on our precious NHS budgets. We have tried various schemes to stem the flow of patients into 999 and A&E. But we make little impact. 

When I got the chance to influence urgent care through the Darzi Review process, back in 2007, I jumped in with great enthusiasm. During our discussions, we agreed it would be a brilliant idea to have a simple telephone number to ring, giving us access to an up-to-date directory of services in our area. And then we had a braver idea: why not open the line to patients and their carers too?

From this brave idea, the NHS 111 number was born.

A number of areas were chosen to pilot the 111 number, including mine in the East Midlands and I was asked to be the local clinical lead for the service.

What NHS 111 offers is a simple route into urgent care, a safety net to identify patients who really do need a 999 response, an assessment of the patient's needs and, if necessary, ongoing referral to services in the local directory. It also provides a wealth of data about who is calling and for what reason and where they are advised to go. It identifies gaps in services. It identifies popular and not-so-popular services.

NHS 111 is a service that GP Commissioners need to get involved with.

The 111 number will be active in all areas of England by April 2013. Understandably, there has been some resistance to another telephone assessment service. But I would urge every single GP involved in GP commissioning to get involved in the development of NHS 111 plans in your own area.

Why? Because NHS 111 will have a profound impact on the delivery of urgent care. As well as providing an additional number to deflect unnecessary 999 call outs and A&E visits, the 111 number can be used to front-end out-of-hours services.

One unpredicted consequence is a decrease in the number of patients requiring onward referral to the GP OOH service. The need for telephone triage is almost abolished – NHS 111 provides this. The worried well and those with minor complaints are weeded out. But those patients who are referred to the OOH service tend to be sicker, more complex, and more likely to require face-to-face consultations.

Through the governance structure of your local NHS 111 services, you will have the opportunity to feedback on what happens to your patients and their experience of the service, you may choose to play a part in reviewing some of the more difficult calls, and you will certainly want to be involved with commissioning the services to which the patient is subsequently referred.

NHS 111 is not just a new telephone number. It is a new way of delivering urgent care.

Dr Ruth Livingstone is a GP in Stamford and East Midlands 111 Clinical Lead