NHS 111 line increases the heavy burden on GPs and A&E departments

Posted: 04/02/2015

Leading doctors are warning that the NHS 111 service is unnecessarily referring too many patients to doctors and A&E departments. The BMA has found that the number of callers to NHS 111 who were referred to GP services had risen 186% between 2013 and 2014 while referrals to A&E departments were up 192%. The BBC has reported concerns that, as staff have little or no medical knowledge, they cannot properly assess how callers should be dealt with and patients are being given incorrect advice. The Primary Care Foundation research group has estimated that the number of calls in which patients were told they could safely treat their own condition fell from 48% in 2012 to an average of 15% in 2013 and 2014. 

Dr Charlotte Jones, BMA's GP lead on NHS 111, said: "There is no doubt that if a patient needs any form of medical care they should be referred through to an appropriate doctor or nurse, but there are serious doubts as to whether this huge increase in workload is clinically necessary. 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, advising a patient on how to self-care, such as picking up medication from a local pharmacist". 

Dr Mark Porter, who chairs the BMA’s ruling council has urged the Government “to do a serious and 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. This should lead to recommendations to increase the amount of self-care patients were undertaking and raise the number of expertly trained clinicians answering calls from patients”.

The Guardian has reported that NHS England denies the charge that 111 providers send too many patients to A&E departments. In the busiest festive week, the percentage of callers recommended to attend an emergency department fell from 8% to 6% and referrals to ambulances dropped from 11% to 10%. However, the actual numbers of people increased due to the higher volume of calls received.

NHS England Acute Care Director, Professor Keith Willetts said: “NHS 111 is doing an excellent job in terms of protecting both A&E and ambulance services from unnecessary attendances and call outs. Doctors and nurses in A&E work incredibly hard to provide patients with the urgent care and treatment they need and have managed significant pressures as demand for urgent care grows. Last year 111 received over 12 million calls and as a result offered treatment to over 2 million people who would otherwise have visited A&E, and another 580,000 who would have called 999 for an ambulance, reducing a significant amount of unnecessary pressure on our urgent care services."

A spokesman for NHS England has also commented that there is a massive demand from the public for the 111 service: "To date, it has coped impressively with this pressure, with the proportion of referrals to GPs and emergency services remaining steady despite the surge in demand” and it is “continuing to look at ways to make the service even more robust including asking GPs to help support call centres and provide patients with the ability to get high quality medical advice as quickly as possible.” 

Camilla Wonnacott, associate in the clinical negligence department said: “All these statistics are extremely worrying given the recent pressures the NHS is facing from staff shortages, rising major incidents and A&E departments missing their four-hour waiting time targets for the last 15 weeks. It is important that patients have an initial enquiry service such as 111 that they can rely on for advice and which takes the pressure off over-stretched GP and A&E services.”

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