NHS 111 call handlers will triage patient calls to GP practices in a pilot project that is under development in London.
Under the plans, which are being worked on by the London Ambulance Service (LAS) and GP practices covering 1.5 million patients in the capital, patients would be automatically diverted to NHS 111 during busy times of the day.
Paramedics, as trained healthcare professionals, could also help support 111 call handlers by dealing with simple medical concerns directly over the phone, The Times reported.
LAS chief executive Daniel Elkeles told the newspaper that the aim of the pilot is to increase patient access to their GP practice while also reducing the number of people calling an ambulance or going to A&E because they cannot reach their GP.
In April, the Labour Party claimed that 18% of patients attending A&E did so because they were not able to get a GP appointment last year, amounting to 4.5 million attendances.
Mr Elkeles said: ‘We need to get primary care to work again and for patients to think they’re getting satisfaction with it.
‘I think the 111 providers could refocus some of what we think is our core business to help make that happen. It could be game-changing.’
He said the LAS has a ’24/7 telephony infrastructure’ that they would like to use to ‘support primary care’ while also ensuring that the workload coming into 999 is ‘genuinely really sick people’.
Mr Elkeles said this new pilot could help to end the ‘8am rush’ as patients would still feel as though they were contacting their GP practice rather than ringing 111.
He said: ‘We can use the GP IT system. We could go through the questions that the GP would have asked or the receptionist would have asked or you could have done digitally yourself and then we could navigate the patient to the right place.
‘You’d be freeing up loads of time in primary care for the GPs to see the patients who really need them, because we’ve taken away a chunk of the work.’
Earlier this year, it was reported that patients calling an ambulance could now be advised to see their GP instead in an effort to improve response times.
Dr Simon Abrams, a GP in Liverpool and chair of Urgent Health UK, said that ‘as an overflow service’ the idea is not ‘unreasonable’, and that the ‘111 service has a level of sophistication that would enable it to deal with some of those issues’.
However, he said the main issue to address in primary care is under-staffing and the lack of investment.
He said: ‘I think it’s unfortunate that GP practices just haven’t got the resources to provide the appointments that are needed by are population, which is being caused by the under-recruitment of general practitioners and just a shortfall of clinicians in practices to enable them to do deal with the problems.
‘I think the solution lies in better investment in primary care, and there has been a significant under-investment of time, money and resource into general practice in the last few years.’
He also said that while 111 has the ‘adequate’ technology, it cannot necessarily offer the personalised approach and continuity of care that primary care offers.
This funding was aimed at implementing modern telephony systems so ‘patients never get engaged tones’, while the recovery plan also announced a major expansion of the receptionist role to become expert ‘care navigators’.
And under the updated contract, imposed this year, GP practices must offer patients an assessment or signpost them to an appropriate service on first contact.
Those who proposed this idea of asking poor patients to ring 111 have never tried 111. It is a nightmare now without this new idea. I had personal experience of trying 111.. please please try it.
“Mr Elkeles said: ‘We need to get primary care to work again“
Bit of a give away there. Clearly the head of the London Ambulance believes that GPs aren’t working
The problem is that 111 is a signposting service only, and is risk averse. It signposts patients back to GP, A&E or 999 largely so I can’t see how this will help with GP workload. They also generate pages of bewildering handover information to practices which waste practice time reading. Allow 111 to see, examine, prescribe and investigate and this might help.
Ambulances for all!
sadly we are moving away from personalised care based on continuity and knowledge of local population to generic, call centre based indifferent protocoled “care”. total nonsense in my opinion
What a bizarre idea. It already takes 111 up to 30 minutes to answer the phone . We have literally hundreds of calls each day , the majority of which aren’t asking for an appointment but want medication , or a sick note , or want us to chase results from the hospital , or want us to chase hospital appointments , or want results of tests we have organised . Are they going to deal with all this themselves or just hand back to GP receptionist and therefore duplicate the majority of calls .
Have they got round to assessing the workload generated by 1111 yet?
It might be best to assess whether the current workload and access issues aren’t caused by 111 before investing more in this model.
For the gazillionth time, the phones / answering the phones / diverting the phones is not the problem.
The problem is the limited number of appointments at the end of it due to the dwindling workforce and GPs leaving. Even if, miraculously, 111 were able to answer the phones in a reasonable timescale there wouldn’t be any slots left and they would lack the huge patient knowledge that our receptionists have built up over the years.
Also, maybe get your own house in order first. I’ve spent 5 minutes looking at the POS 111 discharge summary for a patient and amongst all of the useless negatives I’m struggling to find a reason for the call.
Mr Elkeles said: ‘We need to get primary care to work again’
Once again there is someone quite senior promoting a false narrative that general practice is failing or not working, and using it as an excuse to disempower us and take our autonomy to control our own front door away from us.
Meanwhile, I can think of something that isn’t working – the London Ambulance Service. General practice contributes very little to their workload. Maybe Mr Elkeles could and should concentrate on sorting his own service out?
Whilst all the above comments are valid and deserve a response, the reality is that at the present time 111 is already trying to deal with patient’s calling their Gp, often as early as 08.30, Monday to Friday, when the receptionist tells everyone there are no appointments available today and to call 111. Also 111 picks up the calls when surgeries are closed for ‘training’ and has had added input with the nursing and doctor strikes. These calls are often then triaged by a clinician and whist there are limited options available, the current directory of services presented does enable the triaging clinician to arrange for either a Gp 111 telephone appointment, referral to UTC and, if necessary emergency admission or ambulance disposition., as well as prescribing and contacting mental health teams. In an ideal world, none of this would be necessary but as things stand, for patient safety, something needs to be in place and the 111 infrastructure with IT backup is probably the sensible option.
Laurie Jacobs, thank you for your comment but unfortunately it is disconnected from reality.
111 triaging will be with an algorithm- have you seen current 111 triaging and how difficult it is to make any sense of it at this point?
What will 111 do differently from the local GP staff who can actually personalise care for patients rather than patients being just a statistic.
Even if the problem was the 8am rush (definitely not the problem. The main problem is there are no practitioners medical or not, to put these patients into), the best people to handle these patients first contact are the team that know these patients best and that is the team in the individual surgeries. It will save time and money.
111 might be handling some calls now. Imagine if they have to handle for all the patients of all the surgeries? Wouldn’t it be better to actually put the staff in the surgeries and let them deal with the patients that they know and patients deal with the staff they know?
Ambulances for all.
Go straight to A&E.
Is the patient still breathing? You will get a call back within 8 hours, and it could be in the middle of the night.
Dear All,
Mr Elkeles is Cleary algorithmically driven. Someone somewhere with any sense please pull out his plug. The man’s an idiot.
Regards
Paul C
Daniel Davies, I respect your views 100% but as the Gp workforce is what it is and appears to be working to maximum capacity, something needs to be in place to manage the demand. The reality is at present in many practices, the default button is already 111 and after the initial triage by a 111 call handler, the patient is then put in a queue to speak to a clinician. Whist accepting that the algorithm used initially by the call handlers is not ideal and risk averse, most patients seem to accept it all and are then placed in the queue. Basically it’s exactly the same system that happens out of hours- well at least in the area I am familiar with (Cambridgeshire, Bedfordshire, Herts, Essex) . I was an inner city Gp for 35 years and since retiring have continued to support OOH and since Covid 111, so I do understand workload and demands. Look nothing can replace the expertise of the Gp and the primary care team which are indispensable but if 111 can take some pressure off the system, then take it….like us older GPs did when the government offered us a way out for ‘out of hours’ care.
The problem is that the GP acceptance of the OOH deal offered is that it caused the instant demise of the GP OOH coops, who were providing innovative care models ( OOH Centres, proper computer assisted triage ( with nurse/ GP input ) .
This was
OST in a flash and we have spent 20 yrs reinventing the wheel!
Laurie love I think you must be living in a parallel universe. Have you ever worked in 111/OOH or tried calling them. I work weekdays in surgeries and weekends in 111/OOH Devon and Somerset. It is by far the shitest part of the health services. Some weekends it takes 24-48 hours for patients to get a clinician input, the generic pathways don’t add anything useful. I’ve had elderly patients who can’t mobilise waiting 48 hours for any clinical review, literally the phone call after the 111 pathway identified they need a phone call. This would never happen with surgeries. The receptionists know what needs prioritising and the most vulnerable and urgent will get input that day, usually that morning. 111 online is a joke. It just generates a phone call from clinician for everything. To be fair 111 could work better if there were way more clinicians but we are the rate limiting step for all these services and surgeries use us a lot better than 111.
It is time the government respected the efficiency and remarkable adaptability of primary care and just funded us better so we can expand what we do; ie provided by far the most efficient, flexible and effective part of the NHS.
Any money directed elsewhere is a waste of money.
I can’t work 7 days a week.
Nearly everyone in OOH works in primary care also and we are short everywhere.
111 call handlers add nothing, it is just pass the parcel of risk holding from a creaking GP/OOH/A&E/hospital system that is crashing.
Everyone needs to recognise 111 does nothing apart from cover the proverbial arse of risk, and does that badly, and then redirect funding to any other services than them.
I worked for OOH prior to 111 when devon doctors out of hours got our OOH calls directly. Worked pretty well. Had out own call handlers, much higher percentage of clinicians and patients were fairly sensible about triaging themselves between 999, A&E, out of hours GP and wait until Monday.
I don’t think 111 handlers add anything to a patients own interpretation of disposition.
111 was a dumb idea by David Cameron that fucked up out of hours.
Minimise its input and put any additional funding directly into primary care. Additional receptionists would be far better than 111 call handlers.
Have you read the twatty pathways.
I’ll take a GP receptionist any day. Very capable staff, unrecognised for the enormous service they do the NHS.