NHS 111 is a free-to-call single non-emergency number medical helpline operating in England and Scotland. The service is part of each country's National Health Service and has replaced the telephone triage and advice services provided by NHS Direct, NHS24 and local GP out-of-hours services. The transition was completed in England during February 2014 with Scotland following during April 2014.
The service is available 24 hours a day, every day of the year and is intended for 'urgent but not life-threatening' health issues and complements the long-established 999 emergency telephone number for more serious matters, although 111 operators are able to dispatch ambulances when appropriate using the NHS Pathways triage system.
NHS Direct Wales continues to operate via 0845 4647, but it is intended the 111 service will be offered from some point in 2015.
Origins and development
During 2007, the Department of Health's Our NHS, Our Future report identified confusion surrounding access to certain NHS services in England and suggested the introduction of a national, three-digit number for out-of-hours healthcare services could help simplify the situation. Arrangements to identify and secure a suitable non-emergency number for England began in July 2009, with the number 111 allocated by telecommunications regulator Ofcom in December of that year. The health services of Northern Ireland, Scotland and Wales will be able to introduce their own similar services using the same number if they choose to do so.
In late August 2010, the Conservative-Liberal Democrat coalition government proposed that 111 could replace the existing NHS Direct (084546 47) telephone helpline in England. This suggestion proved controversial as it was seen by some critics as a "cut-price" replacement, due to likely replacement of NHS Direct with NHS 111 telephone advisors lacking professional training in healthcare. Although then-Health Secretary Andrew Lansley denied plans to close NHS Direct in England, explaining that existing staff would provide the new service and that merely the phone number would change., it was announced in October 2013 that NHS Direct would be closed down in 2014.
The first trial, in County Durham and Darlington, started on 23 August 2010, with Nottingham starting on 18 November 2010, Lincolnshire on 22 November 2010, and Luton on 3 December 2010.
Management of the service
In England, the service is accountable at a Clinical Commissioning Group level but was originally commissioned on a regional basis, with a number of service providers. The largest provider at launch was NHS Direct, who provided services to approximately 1/3 of the UK population and were the previous provider of the national advice service, with other providers including regional ambulance trusts, and out-of-hours GP providers. The lack of clarity as to accountability was criticised in a Deloitte report into the service launch failure by NHS Direct. As of December 2013 all NHS Direct contracts are being services by "stability partner" organisations such as ambulance trusts or GP co-operative organisations. In Scotland, a single national service is provided by NHS 24.
The NHS 111 service will also be available via the harmonised European number for medical advice 116 117 under reciprocal agreements made with fellow European countries to simplify and improve public access to recognised 'Harmonised Services of Social Value'.
Failure of service on initial launch
NHS 111 was launched in a limited number of regions in March 2013 ahead of a planned national launch in April 2013. This initial launch was widely reported to be a failure. Prior to the launch the British Medical Association had sufficient concern to write to the Secretary of State for Health requesting that the launch be postponed. On its introduction, the service was unable to cope with demand; technical failures and inadequate staffing levels led to severe delays in response (up to 5 hours), resulting in high levels of use of alternative services such as ambulances and emergency departments. Dr Laurence Buckman, chair of the British Medical Association's General Practitioners' Committee, described the launch of the service as "a disaster in the making", and recommended delaying the full launch for safety reasons. The public sector trade union UNISON also recommended delaying the full launch. The problems led to the planned launch date being abandoned in South West England, London and Midlands (England). In Worcestershire, the service was suspended one month after its launch in order to prevent patient safety being compromised.
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