The NHS 111 urgent care service has faced severe criticism from GPs and been labelled a "disaster" by one of the BMA’s GP negotiators.
Doctors at last week’s National Local Medical Committees’ conference in London heard representatives attack the service because they claimed it was taking too long to handle calls and referring too many patients to GPs.
Dr Peter Holden, one of the General Practitioner Committee’s negotiators, said the NHS Pathways software used by the NHS 111 pilot sites had "promise" but described the pilot project as “a disaster”.
He also told conference goers that the GPC had no negotiating mandate over NHS 111. He added: “The amount of money that’s gone in to 111 just beggar’s belief.”
Dr Reza Chowdhury, a GP in Luton which is covered by one of the NHS 111 pilots, said he had seen statistics that showed an average call length of 20 minutes, with more than 50% of calls referred back to primary care.
He added: “Its increasing our workload hugely and I have concerns about this service if it is extended nationwide."
However, Dr John Grenville, secretary of Derbyshire LMC, told the conference that his area was also running an NHS 111 pilot and he wanted to wait and see what the results showed. The DH is due to report on the NHS 111 pilots in spring 2012.
Representatives supported a motion which claimed that use of the NHS 111 service had the potential to overwhelm GP practices with unnecessary requests for urgent appointments.
The motion also said that using NHS 111 as the first point of access to GP services would result in poorer access and increased patient dissatisfaction.
© 2011 EHealth Media.
Misleading comments and inaccurate dataRuthL 162 weeks ago
As a GP, and the clinical lead for NHS 111 in the East Midlands, I welcome a discussion on the NHS 111 pilots. But, I do expect any discussion to be based on accurate data.
The minimum data set for 111 can be found here: http://www.dh.gov.uk/en/Publicationsandstatistics/Statistics/Performancedataandstatistics/NHS111MinimumDataSet/index.htm
Itis early days and call lengths vary between sites. Average call length in Luton (the newest pilot) is 13mins and may drop further as the call handlers gain experience. Nationally, the average call length is 8 mins.
Yes, as the result of telephoning 111 more patients may be diverted away from A&E and 999 and into primary care (this includes GPs, community services, walk-in centres and OOH services). But isn't this what we want?
View from the user end of the kaleidoscopepersonal opinion 162 weeks ago
1. I live in the Derbyshire area coverd by the pilot. I know about the 111 service because I work in the NHS. I have spoken to my neighbours and not one of them knows about the service. So how can anyone assess the effectiveness of a service if the majority of the population know nothing about it?
2. The practice at which I am registered is always overwhelmed with people wanting to see a doctor and the only way you can get to see one (unless you give them 2 weeks notice) is to say that your need is urgent. If you are one of the 'worried well' what can you do if you need reassurance that your hangover is not cancer?
3. IMHO, having a service that can filter out some of the 'noise', then GP's lives must be better. Stopping 50% of self referrals I see as a really positive result - but then this is perhaps because I always see the glass as half full.
Triage clubmrtablet 162 weeks ago
The first rule of triage is...
>The most skilled medic doesn't work treatment, he or she is assigned to triage.<
Tickbox approaches are weakest at point of first contact when the problem could be literally anything. As the patient progresses down the road to diagnosis, the breadth of clinical skills required typically diminishes (and often also the depth).
The second rule of triage is...
Increasing ease of access to a triage service preferentialy recruits people who would (correctly) never have contacted a GP or A&E at all. Those in dire straits with (say) a ruptured appendix will usually self-triage to A&E. Those with mild indigestion who would never have bothered to go to a GP Surgery, will happily ring NHS Direct from their sofa.
In triage situations where most people have minor ailments (or no ailment whatsoever) it is >impossible< to pick out those needing urgent attention without also referring on many times as many 'non-urgents'. The proportion of cases referred on who are 'false positives' inescapably rises.
More formally the positive predictive value of a triage algorithm reduces (unless it has perfect selectivity) as the proportion of "really unwells" in the triaged population falls.
Those making spending decisions in the NHS have IMO failed to address these issues. For these are inconvenient if you are determined to...
1. replace skilled staff with "computer says no" minimum wagers
2. keep the "worried well" voters happy by diverting resource from front line clinical services to call centres.
The choice is blunt -
do you want to be able to phone NHS Direct to be reasured you don't need an urgent ultrasound scan for a sore tummy after a drinking binge?
do you not want to wait many weeks for an ultrasound scan when you really need it?
You can't spend the money twice.
Well saidMontmorency 162 weeks ago
This is very similar to the kind of histrionics that greeted NHS Direct. There needs to be a clearer analysis of the data to inform the criticisms: 50 percent of how many calls? How many additional GP contacts has that generated? What proportion of these were inappropriate? What are the costs per call? How do all these figures compare with NHS Direct's performance?
Otherwise it's just so much annecdotal hot air.
Overwhelming but appropriate?Nick Tordoff 162 weeks ago
As I understand it the triage rules have been agreed with the Royal Colleges and are entirely clinically driven. Is Dr Chowdhury saying that the referrals from 111 are inappropriate or just that there are a lot of them.
I suspect that the systems which implement what is supposed to happen rather than mimicing what used to happen. The software is diverting previously inappropriate A+E or Out of Hours attendences back to Primary Care which is the appropriate place for them (as defined by the clinical authorities).
It is noticable that patient satisfaction with telephone access to GPs is one of theareas where the public tend not to think that the practices perform well and one of the elements in the urgent care system which can drive up attendences at A+E.
The message here surely is about the capacity of Primary Care to handle an appropriate workload rather than the software incorrectly identifying referrals.
(puts on tin hat as the flack comes in!)