New NHS "111" telephone service ‘dilutes’ nurse role

The “significant dilution” of the role of trained nurses in the telephone service due to absorb NHS Direct has been laid bare in a parliamentary question.

Health minister Simon Burns has revealed only 38 per cent of staff at a pilot site for NHS 111, the single access point for all non-emergency NHS healthcare services, are registered nurses.


This compares with 48 per cent at NHS Direct, which will be absorbed into NHS 111 by 2013.

Royal College of Nursing director of policy development and implementation Howard Catton said the details on the changes to skill mix were “concerning”.

He said: “It’s absolutely clear this is a significant dilution of skill mix. It’s about a 20 per cent reduction in the trained nursing workforce.

“NHS Direct is a unique service… but on a general medical or surgical ward, for a 20 per cent reduction in registered nursing to be safe, we would have to be seeing a reduction in patients and patient demand.”

Protocol based care was not wrong “in principle”, he said, but there was also a need to retain professional expertise.

For example, deciding whether a casualty should not be moved, or whether they needed to be moved to protect their airway.

Mr Catton also expressed concern about the training NHS 111 nurses receive.

While NHS Direct’s nurse advisers complete a month long classroom based training course, followed by a further four weeks of taking calls under clinical supervision, clinical training at NHS 111 amounts to a four day module, after a general two week course with non-clinical staff.

Around six weeks later, all staff then take part in a one day assessment.

The details were set out in answer to a written parliamentary question from Labour MP Ian Austin.

NHS 111 is being piloted in County Durham and Darlington. The pilot is due to be expanded to Nottingham, Lincolnshire, and Luton, before national rollout by 2013.

In August, health secretary Andrew Lansley appeared to suggest the new number would replace NHS Direct altogether, but later clarified the old phone number was merely being phased out.

A Department of Health spokeswoman this week confirmed that NHS 111 would “absorb” NHS Direct. An evaluation of the pilot has been commissioned, which will determine the final skill mix of the service.