The NHS 111 service is designed to provide advice to those who have concerns about their own or someone else's health but are unsure whether the health problem is serious. NHS 111 is available 24 hours a day, 365 days a year. Calls are free from landlines and mobile phones. If someone feels that the situation is life-threatening they should call 999.
In 2013, NHS 111 replaced NHS Direct which provided a nurse-led advice line for patients. Call advisers at NHS 111 are not medically trained. Following a training course, call advisers use a computer programme called Pathways to analyse the symptoms described by the patient. The programme guides the call adviser through a series of questions and then provides advice on the action the patient should take.
Since our last article, which highlighted concerns that the Pathways computer system was too risk-adverse with too many patients being referred to GPs and A&E departments, a number of other concerns have been raised.
In May 2015, the GP journal, The Pulse, published a survey which suggested that only one in four of NHS 111’s referrals to GPs is clinically appropriate. Seven out of ten of the GPs who responded to the survey felt that the majority of referrals from NHS 111 were inappropriate.
There are particular concerns about call handler training and the back-up that call handlers are supposed to receive from medically trained staff. In June, a Telegraph reporter working undercover at NHS 111 concluded that "the organisation fails sick Britons." In September, a former NHS 111 call handler, who had worked at the Derby Centre, told the Daily Mail that she considered the service to be "dangerously understaffed" with call handlers "swamped" and staff under "massive" pressure.
Following the Daily Mail article, Health Minister Ben Gummer has asked NHS England for "assurances" that the NHS 111 service is "doing all it can for patients". Mr Gummer commented that "NHS staff should be overseen by clinical experts, including nurses, in every 111 centre." The Royal College of Nursing has said that "shifting to deliver this service on the cheap has been a real false economy, with people either not receiving urgent advice or making unnecessary trips to A&E." The Patient Association has raised concerns that, as we approach the winter season, the failings of the NHS 111 service need to be addressed.
Camilla Wonnacott, associate in the clinical negligence department, said: “Anyone with medical concerns need to be sure that, when they seek help from NHS 111, they are receiving the correct medical advice, properly backed-up by medical staff where required. The advice should neither endanger the person with the medical problem nor needlessly tie up the resources of the emergency services and out-of-hours GPs. Sadly, it is clear that the NHS 111 service has some way to go before it meets these exacting standards.”