We review the background to NHS 111 and consider what measures have been put in place to ensure patient safety.
What is NHS 111?
NHS 111 is a telephone triage service, the aim of which is to make it easier for patients to access local NHS healthcare services in England. The NHS 111 website confirms that you should use the service if you urgently need medical help or advice but it is not a life threatening situation. It states you should call 111 if:
- You need medical help quickly, but is not a 999 emergency.
- You think you need to go to A&E or need another NHS urgent care service.
- You don’t know who to call or you don’t have a GP to call.
- You need health information or reassurance about what to do next.
How is it run?
The service is staffed by a team of advisers, supported and supervised by nurses and paramedics. When a patient telephones 111, the staff will ask the patient questions, leading him through a set of pathways to assess his symptoms.
They will then give the patient the healthcare advice they need or direct them to local services that can best help. These services could be A&E, an out-of-hours doctor, an urgent care or a walk-in centre, a community nurse, an emergency dentist or a late opening chemist.
How is it different from NHS Direct?
NHS Direct was a telephone service staffed by mainly doctors and nurses, providing the same service as NHS 111 in an attempt to triage patients without them needing to attend another healthcare setting. NHS Direct still exists, and provides the NHS 111 service in approximately one third of the country.
Who is responsible for NHS 111?
NHS 111 is being delivered by various organisations, including NHS Direct and Harmoni. This means a call will potentially be answered by a different organisation depending on what part of the country the caller is in. Ultimately however, the overriding organisation responsible for NHS 111 is NHS England.
Earlier this month, NHS 111 data was published for August 2013. This showed that of those who used NHS 111, 92 per cent were satisfied with their experience. In August 2013 there were 548,318 calls to the service, a slight reduction on the figure for July 2013. The majority of NHS 111 services in England are meeting the performance standards (94.1 per cent of calls were answered in 60 seconds and just 0.5 per cent of calls were abandoned after waiting longer than 30 seconds). The average length of a call was 14 minutes 31 seconds, with 85.1 per cent of callers receiving triage and 7.3 per cent of all answered calls offered call back. On average, 30.7 per cent of call time was handled by clinical staff for all calls in August.
Ensuring patient safety
The types of calls to NHS 111 can vary widely. Steps need to be taken to ensure that the safety of patients is protected. Full emphasis in training should be placed on ensuring the correct pathway is used. It should be also emphasised that should a telephone operative not be sure of the correct pathway, they should always advise the patient to attend A&E or attend an emergency appointment with their GP.
Another way to protect patient safety is potentially to end all calls with a "safety net" such as "if your symptoms deteriorate, please attend A&E as soon as possible". This phrase will of course vary depending on the nature of the call.
All providers should ensure calls are recorded with the consent of the calling patient. This will avoid any factual discrepancies should issues arise as to the nature of the advice provided. Whilst some commentators have raised concerns as to the training of the non-clinical staff involved in the service, NHS 111 has confirmed their staff undergo detailed and comprehensive training, and sign off to confirm complete competence, before they are allowed to take calls. Clinical supervision is provided on all shifts to provide support and identify issues immediately. A percentage of calls taken by each NHS 111 adviser every month are audited.
As long as a full training regime is implemented with regular periodical review, and pathways are kept up to date with current medical practice, this service should add to the comprehensive healthcare system we have today. This would assist in decreasing attendances at A&E and out-of-hours GP services, relieving pressures on those services and allowing more time to be spent with patients.