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NHS 111 redirects callers from A&E to general practice

Advises 60% of callers to go to GP not A&E; a third would have done so without advice

Louise Prime

Friday, 24 February 2017

The NHS 111 telephone service in England has redirected a large number of people from emergency care to general practice over the three years that it has been in operation, an independent report has concluded. But the number of callers to NHS 111 who are referred to the emergency services has still risen by more than a third in this time.

The Nuffield Trust, an independent health think-tank, has revealed in its latest report that NHS 111, which replaced NHS Direct in 2013, is sending a higher than ever absolute number and proportion of its callers to A&E or ambulances – but without telephone advice, a far higher proportion of callers said they would have gone to A&E or called an ambulance, so the service is reducing pressure on emergency services. And it also found that NHS 111 advice results in almost twice as many callers going to their GP as would otherwise have done so.

The number of people calling 111 who have either been advised to go to their local A&E unit, or been sent an ambulance, has increased from around 150,000 a month to over 200,000 a month over the past three years. The proportion of callers sent to A&E and ambulances has also risen, from about 18%-19% in the early period of the service to about 20%-22% now, equivalent to about an extra 20,000 people a month.

But further evidence indicates that the call line is actually reducing, rather than increasing, pressure on emergency services. User surveys have found that whereas 45% of callers said they would have gone to A&E or called an ambulance if they hadn’t been able to access 111, call handlers only send about 20% of callers to these services.

In contrast, just over a third of users surveyed said that if NHS 111 hadn’t existed they would have gone to primary and community services such as their GP; but NHS 111 sends about 60% of callers to these services. The Nuffield Trust said: “So the evidence appears to suggest that over the three years it has been in operation, NHS 111 has redirected a large number of people from emergency care to general practice.”

The report’s authors also found that although in general NHS 111 seems to steer people away from emergency services, there is great variability across England. In some areas, they said, NHS 111 is probably too risk averse, as it is connecting more people to the ambulance service than sending people to A&E – which is the reverse of the usual pattern of NHS use. They reported that 17% of all callers in north east England were transferred to an ambulance in 2016, but only 8% in south Essex; and the proportion of people who were not recommended on to another service ranged from 8.45% in Hampshire and Portsmouth to 25% in inner north west London.

Professor John Appleby, Nuffield Trust chief economist and director of research, commented: “Halfway through one of the toughest winters the NHS has endured in recent times, we wanted to see whether there was any truth in the assertion that referrals from NHS 111 may be contributing to the pressure on A&E departments and ambulance Trusts. What we found was a bit of a mixed picture. It’s a concern for the NHS that the proportion of callers sent to A&E and ambulances is growing all the time; but surveys of callers appear to show that even higher numbers would have opted for these emergency services if they hadn’t been able to ring 111. What’s not clear is why different areas are sending such varying numbers of callers to ambulances and A&E, and it would be worth NHS England or the Department of Health investigating the reasons for this.”

* Dayan M. Winter Insight Briefing 2: NHS 111. Nuffield Trust, February 2016. Weekly and monthly data until 5/2/17 analysed.

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