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NHS 111 overhaul to ensure service ‘definitively manages’ calls

NHS 111 call handlers will have access to patient records and more clinical support under a major revamp of the urgent care phoneline announced today.

NHS England said it would release a new service specification for NHS 111 over the next six months designed to ‘definitively manage’ patients’ problems rather than simply providing advice.

NHS medical director Sir Bruce Keogh announced the move, which will see call handlers being able to directly book GP appointments and allow patients to speak directly to a nurse, doctor or other healthcare professional ‘if that is the most appropriate way to provide the help and advice they need’.

Pulse reported last month that CCGs had been blocked from securing permanent arrangements for NHS 111, after NHS England halted any reprocurement of the service until April 2015.

But Sir Bruce promised that the new service specifications will be announced within six months in order to prepare for a full rollout from 2015/16.

The revamp follows a troubled start to the helpline, which has led to the biggest provider NHS Direct pulling out of NHS 111 contracts, and GPs raising concerns that non-medically trained call handlers are directing more patients towards urgent and emergency services.

However, under the new proposals, there will be teams of medical professionals working with the service to provide far more opportunities for patients to speak to clinicians.

The report stated: ‘We must help people with urgent care needs to get the right advice in the right place, first time. To achieve this, we will greatly enhance the NHS 111 service so that it becomes the smart call to make, creating a 24-hour, personalised priority contact service.’

‘This enhanced service will have knowledge about people’s medical problems, and allow them to speak directly to a nurse, doctor or other healthcare professional if that is the most appropriate way to provide the help and advice they need. It will also be able to directly book a call back from, or an appointment with, a GP or at whichever urgent or emergency care facility can best deal with the problem.’

The report added that it is aiming within the next months for ‘the completion of the new NHS 111 service specification so that the new service (which will go live during 2015/16) can meet the aspirations of this review’.

Professor Jonathan Benger, NHS England’s national clinical director for urgent care, said the aim was for clinicians to ‘definitively manage’ patients’ problems.

He said: ‘At the moment 111 is performing at the highest standard. The vision we have of 111 is it should be a more comprehensive and effective service. We are trying to move it away from an advice-led service giving advice about what you should do next to one where you are definitively managing the problem for that patient.’

‘So a patient rings up and if the problem can be dealt with over the phone, it is dealt with over the phone. That telephone call should do its utmost to resolve that need.’

Dr Richard Vautrey, deputy chair of the GPC, said he was pleased there would be a ‘better balance’ between lay and clinically trained call handlers, but was sceptical about access to patient records.

He said: ‘In reality, access to a patient’s full record often does not make much difference in management of patients because it is the urgent presentation that needs to be dealt with, and clinicians will have the experience to do that and make the right decisions.’

Dr Agnelo Fernandes, urgent care lead and national clinical commissioning champion at the RCGP, said there were ‘workforce issues’ around using more clinicians.

He said: ‘Clinicans are in short supply so if you want to develop models that are on a huge scale, you need to know where the clinicians are going to come from. If it is GPs, where are those GPs going to come from?’