NHS 111

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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[1] with Scotland following during April 2014.[2] NHS Direct Wales started a phased roll-out of a similar 111 service in late 2016.[3]

The service is available 24 hours a day, every day of the year and is intended for 'urgent but not life-threatening' health issues[4] 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.[5][6]

NHS Direct Wales continues to operate via 0845 4647, but began a transition to 111 during late 2016, with 111 currently being trialled in some areas. The health service of Northern Ireland will be able to introduce its own similar service using the 111 number if it chooses to do so.

Origins and development[edit]

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,[7] with the number 111 allocated by telecommunications regulator Ofcom in December of that year.[8]

In late August 2010, the Conservative-Liberal Democrat coalition government proposed that 111 would replace the existing NHS Direct (084546 47) telephone helpline in England.[9][10] This suggestion proved controversial as some critics feared that NHS 111 would be a "cut-price" replacement for NHS Direct, because NHS 111 would be staffed mainly by telephone advisors whereas NHS Direct had been staffed by nurses. Health Secretary Andrew Lansley said that the only major change would be the phone number, and that the service would be provided by existing staff.[9][11][12]

In July 2015 NHS England decided that what was required was an integrated urgent care access, treatment and clinical advice service which would operate over a large area. Clinical Commissioning Groups were told to stop any procurement exercises until revised commissioning standards and supporting procurement advice for integrated services were produced.[13]

Management of the service[edit]

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. NHS Direct staff provided some of the 111 service during the original launch of the number, 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 serviced by "stability partner" organisations such as ambulance trusts or GP co-operative organisations.

The service operates 24 hours a day. When GP surgeries are closed normally between 6.30pm and 8am, at weekends and at Bank Holidays the service will refer many patients to an out-of-hours service. This can also happen if practices are closed for training purposes.[14]

The service uses a clinical decision support system which structures the response to a call, which may range from telephone advice to the dispatch of an emergency ambulance. Calls are initially assessed by a call handler and may be passed to a clinician. The service has been criticised for being too cautious and directing too many patients to A&E departments.[15] GPs have complained that the service has not been inspected by the Care Quality Commission and that it may jeopardise the safety of out-of-hours services.[16]

Between 2010 and 2015 the service has handled 24 million calls with an average call length of 14 minutes. 97% of calls made have been answered within 60 seconds. Although 111 is a helpline for non-emergency cases, 10% of calls trigger the dispatch of an ambulance - 93,000 in the 12 months from April 2014 to April 2015.[17] A 2017 article in the British Medical Journal that studied the performance of the 111 service concluded that patients were "largely satisfied" with the service, while "its success against some key criteria has not been comprehensively proven."[18]

Launch and initial service failures[edit]

The first trial, in County Durham and Darlington, started on 23 August 2010. Nottingham, Lincolnshire and Luton began trialling the service later that year.

NHS 111 was launched in a limited number of regions in March 2013 ahead of a planned national launch in April 2013. The British Medical Association wrote to the Secretary of State for Health to request that the launch be postponed.[19] Its chair, Dr Laurence Buckman, warned that the service as "a disaster in the making", and recommended delaying the full launch for safety reasons.[20][21] The public sector trade union UNISON also recommended delaying the full launch.[22]

The initial launch was widely reported to be a failure.[23][24] 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.[25][20] The problems led to the launch being delayed in South West England, London and Midlands (England)[26][27][28] and the service was suspended one month after its launch in Worcestershire.[29]

The 111 service was gradually launched in England over the course of 2013, with the rollout being completed in February 2014.[1] It was announced in October 2013 that NHS Direct would be closed down in 2014.[30] The 111 number was launched in Scotland in April 2014.[31]

European number[edit]

The NHS 111 service is also 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'.[32][33][34]

References[edit]

  1. ^ a b http://www.healthcare-today.co.uk/news/february-will-see-the-last-nhs-111-sites-go-live/24920/
  2. ^ http://www.nhs24.com/111
  3. ^ http://www.nhsdirect.wales.nhs.uk/news/?gcid=661
  4. ^ [1] Archived August 31, 2010, at the Wayback Machine.
  5. ^ "NHS Direct delivering NHS 111 in East Midlands and East of England". NHS Direct. December 2010. 
  6. ^ "NHS Pathways". NHS Connecting for Health. Retrieved 2013-06-05. 
  7. ^ "Ofcom | A Three-digit Number for Non-Emergency Healthcare Services". Stakeholders.ofcom.org.uk. 2009-08-20. Retrieved 2013-05-01. 
  8. ^ "Ofcom | New 111 non-emergency healthcare phone number confirmed". Media.ofcom.org.uk. 2009-12-18. Retrieved 2013-05-01. 
  9. ^ a b "NHS Direct launches". NHS Direct. 28 August 2010. 
  10. ^ "Government confirms plan to scrap NHS Direct helpline". BBC News. 29 August 2010. 
  11. ^ "UNISON Health Care - Our NHS Our Future". Unison.org.uk. Retrieved 2013-05-01. 
  12. ^ Bob Roberts (2010-09-10). "NHS Direct to continue after ConDem 'climbdown' - Mirror Online". Mirror.co.uk. Retrieved 2013-05-01. 
  13. ^ "All 111 and out of hours tenders suspended". Health Service Journal. 8 July 2015. Retrieved 8 July 2015. 
  14. ^ "Patients turned away after GP surgeries are all shut on the same day". Local Berkshire. 11 October 2014. Retrieved 11 October 2014. 
  15. ^ "Too many patients call the 111 NHS hotline and end up at A&E". The Sentinel. 15 September 2014. Retrieved 11 October 2014. 
  16. ^ "Concern over NHS 111 as CQC praises GP out-of-hours care". GP Online. 3 October 2014. Retrieved 11 October 2014. 
  17. ^ "How NHS 111 helpline refuses to send out ambulances". Daily Telegraph. 30 June 2015. Retrieved 1 July 2015. 
  18. ^ "Has the NHS 111 urgent care telephone service been a success?". British Medical Journal. 2 June 2017. Retrieved 28 November 2017. 
  19. ^ "BMA – GPs urge delay to phoneline implementation". Bma.org.uk. 2012-02-25. Retrieved 2013-05-01. 
  20. ^ a b Sophie Goodchild, Health and Social Affairs Correspondent (2013-03-22). "Lives are being risked by five-hour delays on NHS helpline, say GPs - London - News - London Evening Standard". Standard.co.uk. Retrieved 2013-05-01. 
  21. ^ "Contract changes and 'chaotic' reform put patients at risk, warns GPC". GPonline.com. 2013-03-22. Retrieved 2013-05-01. 
  22. ^ "Union says it warned NHS bosses about dangers of 111 service (From This Is Wiltshire)". Thisiswiltshire.co.uk. 2013-02-28. Retrieved 2013-05-01. 
  23. ^ "Patients failed by helpline disaster". This is Bath. 2013-03-01. Retrieved 2013-05-01. 
  24. ^ "Launch of new NHS call centre in Lancashire branded a 'disaster' (From Lancashire Telegraph)". Lancashiretelegraph.co.uk. 2013-03-26. Retrieved 2013-05-01. 
  25. ^ Liz Hull (2013-03-24). "New NHS phoneline 'will put lives at risk': Doctors' warning after 111 number goes into meltdown | Mail Online". London: Dailymail.co.uk. Retrieved 2013-05-01. 
  26. ^ "Out-of-hours GP helpline launch called off after trial causes chaos". This is Somerset. 2013-03-23. Retrieved 2013-05-01. 
  27. ^ "BBC News - Shropshire non-emergency medical advice calls diverted". Bbc.co.uk. 2013-03-25. Retrieved 2013-05-01. 
  28. ^ "E-Health Insider :: NHS 111 in 'total meltdown'". Ehi.co.uk. Retrieved 2013-05-01. 
  29. ^ "BBC News - Worcestershire withdraws NHS 111 advice line". Bbc.co.uk. 2013-04-25. Retrieved 2013-05-01. 
  30. ^ "NHS Direct to close down next year". BBC News. 24 October 2013. Retrieved 10 November 2013. 
  31. ^ http://www.nhs24.com/111
  32. ^ "Ofcom | Harmonised European numbers for harmonised services of social value (116XXX numbers)". Stakeholders.ofcom.org.uk. Archived from the original on 2014-07-28. Retrieved 2013-05-01. 
  33. ^ http://helplines.community.officelive.com/111consultation.aspx
  34. ^ https://www.theregister.co.uk/2009/07/09/nhs_111

External links[edit]