Questions Raised About 111 Service

The NHS Alliance has questioned the business case for the NHS 111 urgent care service as the key route into urgent care.


A discussion paper from the NHS Alliance’s Urgent Care Network suggests responsibility for urgent care would be better met by general practice, with the 111 number providing a support service.

The paper, written by Dr Ray Montague, a GP in Bristol and founding director of urgent care provider Brisdoc Healthcare Services, says there is no new money for urgent care, so implementation of the 111 service needs a business case that “stacks up”.

He adds: “As a commissioner I would be very nervous about the impact of 111 on what is already becoming a cash-starved health economy.”

Dr Montague argues that without extra money, 111 would need to deliver reductions in unnecessary 999 journeys, unscheduled admissions, and A&E attendances, whilst also minimising the creation of extra work on others.

The paper adds: “Developing a large scale algorithm based call centre service removed from the influence of the local primary care and local health economy looks unlikely to achieve this.”

Three pilot sites are currently live with the NHS 111 service across England. The NHS Alliance says a further wave of implementation is on the horizon and claims that the “evolving blueprint” is that access to GP out-of-hours services could also be subsumed into 111.

It adds: “By switching GP out-of-hours access to a 111 route we would be implicitly teaching the population that this is the correct place to go 24/7 with urgent health problems.”

Dr Montague argues that this could have a “seismic effect” on urgent care flows if patients who would otherwise present with their urgent care needs in day time general practice were encouraged to go elsewhere.

The document adds: “Routing patients back to general practice should be the paramount objective for 111 yet the current paradigm specifically seems to be routing patients away.”

The NHS Alliance report acknowledges that general practice is “part of the problem” and argues that it needs to raise its game consistently and promote a strategy of GP 24/7 for all urgent healthcare needs.

The Alliance says this will involve addressing telephone access to general practice, setting up fast track systems for dealing with urgent problems and could involve using a locally-based 111 call centre as a backstop to GP telephone access.

The paper says this would mean 111 services would need access to GP appointment systems.

It also suggests that while it may be a long time before GP practices open their doors to external, large-scale organisations such as ambulance trusts “a locally embedded 111 service that is actively engaged in supporting practices may have a better chance of achieving this.”

Rick Stern, lead of the NHS Alliance Urgent Care Network, said the Alliance wanted a wider debate about how 111 could be used to improve access to urgent care.

He added: “One approach is to develop 111 as a vital support sitting behind a new GP 24/7 service, providing back up when general practice is unable to cope or when patients are not registered with a local practice.

"At the same time, it is crucial that we consider all the angles and in particular how a new number can be used to strengthen local health systems.”

Next week’s National Local Medical Committee’s conference will also debate the 111 service.

Grassroots GPs will debate concerns that the 111 service could overwhelm practices with unnecessary requests for urgent appointments that its use as a first point of access to general practice could increase patient dissatisfaction.

Source: NALM