Exclusive GPs or senior nurses could be drafted in to triage borderline cases when the new 111 service is rolled out across London, under proposals being discussed by LMCs and NHS managers.
Londonwide LMCs is in talks with NHS London over adapting the 111 model developed elsewhere in the country to strengthen input from clinicians, amid concerns over the ‘mixed results' of pilots so far.
The model under discussion would see NHS 111 call handlers direct complex cases to GPs or senior nurses for triage rather than dispatching an out-of-hours doctor for a home visit.
The plan would be a departure from existing pilots, running in Nottinghamshire, Lincolnshire, County Durham and Luton, where healthcare assistants use NHS Pathways computer software to judge whether patients should be referred to non-emergency services or given self-care advice.
Londonwide LMCs told Pulse that NHS Pathways worked well for handling clear-cut cases such as patients with minor conditions or those in urgent need of an ambulance, but might be ill-suited to handling more complex situations.
Dr Paddy Glackin, medical director at Londonwide LMCs and a GP in Islington, north London, said: ‘A healthcare assistant using computer software is no substitute for 12 years' training as a GP followed by 10 or 15 years' clinical practice. In difficult cases, a non-clinician simply can't pick up what an experienced doctor or nurse would.'
An NHS London spokesperson said: ‘We are working closely with Londonwide LMCs to involve them in implementation of 111 across London.'
News of the talks came after the GPC raised concerns over ‘operational issues' with 111.
Dr Chris Udenze, a GP in Nottingham, said: ‘The 111 service is not only a waste of time but is directing more people to A&E for simple problems. It is some idiot who's had about 15 hours' training saying either go to A&E, or see your GP for simple things.'