NHS 111 is a free-to-call single non-emergency number medical helpline operating in England and Scotland. The service is part of each region'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. NHS Direct Wales continues to use the 0845 46 47 number.
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 begin coming into service on a phased basis from October 2015. The health service of Northern Ireland will be able to introduce its own similar service using the same number if it chooses to do so.
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.
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.
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.
Management of the service
In England (Scotland and Wales), 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 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.
The service uses a Clinical decision support system which structures the response to a call, which may range from telephone advice to the despatch 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. 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.
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. 10% of calls trigger the dispatch of an ambulance - 93,000 in the 12 months from April 2014 to April 2015.
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.
Failure of 111 service provided by Vodafone
On 22 Feb 2014 the Vodafone system failed, disrupting calls to 111 & 101 between 6:30 and 12:30.
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'.
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