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Near-tripling in NHS 111 callers sent to GP or A&E

Using non-clinically trained call handlers leads to unnecessary NHS work, says BMA

Louise Prime

Wednesday, 04 February 2015

The number of callers to NHS 111 who are advised to see their GP or go to A&E has soared over the past year, as the proportion safely advised to self-care at home seems to have plummeted, the British Medical Association revealed this morning. As it published its latest analysis of referrals from the telephone advice line, the BMA said that using non-clinically trained staff who follow a formulaic script “understandably” leads to a cautious approach, which leads to an unnecessary increase in NHS workload as well as being a huge waste of patients’ time.

The number of callers to NHS 111 between January and October 2014 whom call handlers referred through to GP services shot up by 186% compared with the same period in 2013, from 2,844,452 to 8,138,863, showed the BMA’s analysis of NHS England statistics. At the same time, it found that the number of callers referred to accident and emergency rose by 192% compared with the previous year, from 374,506 to 1,092,967.

The BMA also analysed separate figures from the Primary Care Foundation, on the proportion of calls to NHS 111 estimated to have been designated as ‘self-care’ – i.e. those in which callers were deemed to be able to safely treat their condition on telephone advice from the call handler. Self-care was estimated to have been advised in 48% of calls in 2012, but an average of only 15% in 2013 and 2014.

The BMA pointed out that NHS Direct received 4.4 million calls from patients in its final full year of operation in 2011-12; in comparison, by November 2014 NHS 111 had received and responded to over 15.4 million calls in the year to date – an increase of about 250%. The BMA’s lead on NHS 111 Dr Charlotte Jones commented: “Before it was launched in March 2013, the BMA’s GP committee warned that it [NHS 111] would struggle to cope with demand … There has been a huge increase in the number of people put through to key parts of the NHS such as A&E and general practice.”

She added: “Anecdotally, GPs have reported to the BMA that patients have been referred to them with colds, sore thumbs or other conditions that could have been treated safely by sensible advice over the phone ... The number of calls logged as ‘self-care’ seems to have dramatically fallen since the introduction of NHS 111.”

The BMA said key NHS services, including GP practices, are already struggling under unprecedented pressure to treat those patients who need genuine care – so they cannot afford to take on additional unnecessary workload; and further, it is an “enormous waste of patients’ time” to refer them to a GP or A&E when their problem could be dealt with on the phone in a few minutes.

Chair of BMA Council Dr Mark Porter said: “A fundamental problem with NHS 111 is that it employs non-clinically trained staff who follow a formulaic script rather than using clinical judgement to assess how calls are dealt with. Understandably this is likely to lead the call handlers, with limited experience of medicine, to be cautious and refer patients to the NHS when a trained professional could have encouraged them to effectively self-care.”

He called on the Government to conduct an urgent analysis of the effect of NHS 111 on the wider urgent and unscheduled care system, to determine where it may be working inefficiently and to ensure that it is cost-effective. He said: “This should lead to recommendations on increasing the level of self-care and ensuring that we have a programme to increase the number of expertly trained clinicians answering calls from patients.”

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