NHS Direct has admitted GPs and other clinicians should play a greater role in triaging calls to the 111 urgent care number – and has joined the BMA in calling on ministers to put back the April 2013 deadline for its national rollout.
NHS Direct said ‘preliminary results’ from the four 111 pilots it currently runs showed ‘changes will probably be needed’, and warned ‘unrealistic rollout deadlines’ could make it impossible to learn lessons from the early trials.
Pulse revealed last month that four of the seven 111 pilots across England have been hit by a series of patient safety alerts, with eight of the nine serious untoward incidents reported occurring in pilots run by NHS Direct.
It comes as the BMA formally wrote to health secretary Andrew Lansley urging him to postpone the procurement of 111 services until clinical commissioning groups are in place and the pilots have been fully evaluated.
NHS Direct chief executive Nick Chapman said: ‘The results of the pilots need to be available before clinical commissioners commit to long term contracts to deliver NHS 111 in their area. It would be extremely worrying if the opportunity to learn from the pilots, and make appropriate changes, was lost because of unrealistic rollout deadlines.’
‘Preliminary results are showing us that the service refers more patients for face to face care than existing services. As a result of this, changes will probably be needed. This may include greater use of clinicians – nurses and doctors – to complete more in-depth clinical assessments on the telephone in order to avoid unnecessary referrals to GP surgeries, A&E and ambulance call outs.
In a letter to Mr Lansley, GPC chair Dr Laurence Buckman wrote: ‘We seek your assurance that the procurement of NHS 111 services will be slowed down, to allow for proper evaluation of the pilots; and that you will adopt a flexible deadline for full implementation of the service to ensure that fledgling clinical commissioning groups can play a full role in procurement decisions.’
‘We are concerned that a failure to do this could lead to serious unintended consequences that could be avoided with a more flexible approach.’
In a briefing paper released alongside the letter to Mr Lansley, the BMA warned that in Shropshire local GPs feared a repeat of the ‘chaotic’ introduction of the original NHS Direct service in their area.
Of particular concern were plans to substitute ‘an algorithm process handled by non-clinicians’ for the existing triage team of highly-trained and experienced local clinicians, ‘the very thing that makes GP out-of-hours care in Shropshire of such high quality’, the document said.
Another case study from Nottinghamshire shows that £50,000 was released by the strategic health authority last September to ‘support clinical engagement’ with the project – funding which the BMA claim is proof that clinicians had not been previously engaged.
The NHS Confederation’s Ambulance Service Network also joined the BMA in arguing that the current timeframes for the NHS 111 rollout were ‘just too tight’.
Ambulance Service Network director Jo Webber said: ‘A headlong rush to implementation will not necessarily benefit patients. It is vital to have buy-in first from clinical staff and future clinical commissioners.’
Last week the Department of Health told Pulse it was still working to an April 2013 deadline, and in a statement today health minister Anne Milton said GPs’ concerns would be considered but declined to comment on the deadline.
‘We agree that any long-term decision should be made with full approval from local commissioning groups,’ she said. ‘They should be fully engaged with the approach to delivering NHS 111.’