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Updated Q&A: NHS 111

What is NHS 111?

NHS 111 is a new service that is being introduced in an attempt to make it easier for patients to access local NHS healthcare services. It is intended for when patients need urgent but not emergency care.

The introduction of the three-digit number was intended to help to reduce the number of unnecessary ambulance journeys, reduce avoidable A&E attendances and unscheduled admissions from A&E, and reduce the number of 999 calls for non-emergency issues.

When is it being rolled out?

It was originally supposed to go live across England on 1 April, although last year the Department of Health offered a six-month extension to the areas which needed it, and eight CCGs applied.

However even in the areas which were still aiming to go live on or before 1 April there have been many problems, with a series of troubled ‘soft launches’. Last week Pulse reported that at least 53% of the population in England was unlikely to be covered by the service from 1 April. The BMA has written to Sir David Nicholson, chief executive of NHS England, calling for the rollout to be delayed.

However NHS England claims the current situation does not constitute a ‘delay’. A spokesperson said: ‘The reports that NHS 111 has been aborted are wrong. The service is already live across much of the country. The NHS 111 service is being introduced on a phased basis, which has always been the plan. Many areas in England already have an excellent responsive NHS 111 service for patients and the public. The remainder of the service for England will go live in the next few months. Issues in some areas mean we have slowed down their rollout.’

Who is running the service?

SHAs have been running competitive tendering processes to run the NHS 111 service. The big winners among the providers were Harmoni and NHS Direct, each of which won at least 11 contracts. Derbyshire Health United won contracts for three NHS 111 services, as has the South East Ambulance Service and the North East Ambulance Service. One of the largest contract winners was Yorkshire Ambulance Service/Local Care Direct, which secured the Yorkshire and Humber contract worth £11.5m over five years

What happened during the ‘soft launches’?

Many regions reported problems, with GPs claiming the services in London, Manchester and Birmingham were chaotic. GP leaders reported that out-of-hours providers were being required to take control of call handling and triage because NHS 111 did not have sufficient capacity. Patients reported being on hold for 90 minutes and out-of-hours services said they were either receiving no calls or being overrun with calls.

How successful were the pilots?

Official figures showed an 8% rise in ambulance attendances in areas of the country that piloted the Government’s new urgent care number over a year, compared with 3% in non-NHS 111 sites.

In October 2012, researchers at the University of Sheffield analysed the first year of operation of NHS 111 across four pilot sites and compared it with other matched control sites without NHS 111. It said the pilots had ‘not delivered the expected benefits’ in terms of improving patient satisfaction or stemming the flow of patients being directed to emergency care. They also warned it ‘cannot be assumed’ that the scheme would produce the expected benefits with increased use and time, and that they expected it to be more costly than current arrangements.

The report found that overall satisfaction with the service was good, with 73% of respondents to a survey of users reporting they were very satisfied, and a further 19% quite satisfied. But it highlighted that ‘there was no evidence that NHS 111 improved satisfaction with urgent care generally’.

What are the other issues?

The GPC has highlighted a number of concerns. It claimed that overly risk-averse call handling could lead to increased demand for healthcare services and higher referral rates and questioned the potential cost to the NHS at a time of huge financial constraint. It pointed out that some CCGs felt excluded from the process and were worried they would inherit costly and unalterable arrangements for their local area.

There was concern over staffing at the new service - NHS Direct staff in Exeter even worked unpaid to highlight the need for qualified staff on the emergency helpline. Pulse also reported this year that the summaries sent to GPs after calls to NHS 111 are ‘lengthy’ and ‘obscure’, with fears that patient safety could be jeopardised as a result. And finally, there were concerns about the numbers of private providers who won contracts for the services.

Pulse also revealed that GPs were being dumped with following up any patient who contacts the Government’s new urgent care hotline more than three timesover a certain period, in what the GPC claimed amounts to a ‘charter for queue jumpers’.