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NHS 111 increases demand for urgent care, say researchers

Data from the pilots of the NHS 111 urgent care line showed a measurable increase in the numbers of emergency ambulances sent to patients and may be responsible for increased activity in the urgent and emergency care system, a BMJ Open study has concluded.

The study found that there was an increase of 2.9% in emergency activity in the NHS 111 pilot sites compared with the non-pilot sites.

It also found there was an increase in overall activity in the pilot sites ranging from 4.7% to 12% every month.

The study, using data that was first published last year, has been released in the same week that | NHS England has announced an overhaul of the service to allow greater access to clinicians.

It looked at the emergency activity in the pilot sites of Nottingham, Durham and Darlington, Luton and Lincolnshire in the first year of the service’s operation, comparing it with activity in similar non-pilot sites and with activity in the previous two years.

The authors said:  ‘There was no change overall in emergency ambulance calls, emergency department attendances or urgent care use.’

However, they added: ‘There was an increase in activity overall in the emergency and urgent care system in each site ranging 4.7–12%/month and this remained when assuming that NHS 111 will eventually take all NHS Direct and GP out of hours calls.’

‘There is potential that this type of service increases overall demand for urgent care,’ they concluded.

This comes after a major NHS England review recommended an overhaul of the troubled service. Professor Sir Bruce Keogh, medical director of NHS England, called for an increase in the access to clinicans and a move to a service where clinicians are ‘definitively managing’ the patient’s problems, rather than simply giving advice.

An NHS England spokesperson said: ‘With 111 now available to over 93% of the population the data used in the Sheffield study is less relevant due it’s small coverage and not applicable to the whole 111 service.’

‘The four pilot sites used in the study were also operating under a different service specification as to what is currently in place making the study less comparable to the current 111 service.’

‘It would be unreasonable to expect definitive conclusions and benefits to come out of a study which was looking at 111 in the very earliest of stages, especially when public awareness and marketing was limited.’

NHS England said in August that there was ‘no evidence that 111 is increasing demand on 999’ and that the pilots had concluded that ‘dispositions from NHS 111 are clinically appropriate’.

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