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GP commissioning leader defends CCGs over NHS 111 failure

Blaming local commissioners for the failure of NHS 111 in some parts of the country is a “bit rich”, the president of NHS Clinical Commissioners has told HSJ.

At a meeting on Friday the board of NHS England agreed to commission two reviews, one examining the future sustainability of the NHS 111 service model and one looking at lessons to be learned from the NHS 111 programme.

More than a month after the original intended go-live date for the service, providers in almost half of the country are still relying on support from NHS Direct’s 0845 number to meet demand.

NHS England interim chief operating officer and deputy chief executive Dame Barbara Hakin told the meeting questions had to be asked about the commissioning process.

She said: “We need to ask how it was possible that contracts were awarded to providers who, on day one, patently couldn’t deliver the service.”

However, Mike Dixon, interim president of NHS Clinical Commissioners and a leading advocate of clinical commissioning, described Dame Barbara’s comments as a “bit rich”. He said that, although clinical commissioning groups were operating in shadow form during the period 111 was being procured, many were not involved in the process.

He said: “The problems were with the primary care trusts and it wasn’t altogether their fault; they were faced with a national specification, there wasn’t proper negotiation with CCGs and the feedback from the pilots [of NHS 111] wasn’t properly listened to. It was a car crash waiting to happen.

“The system came from the centre and they can’t start blaming frontline commissioners when it has gone wrong in some areas.”

NHS Clinical Commissioners were among the many organisations which previously called for the roll out of NHS 111 to be slowed down. The April 2013 deadline for the roll out gave commissioners just two and a half years to design and procure their service during a period the whole commissioning system was being reorganised.

Dr Dixon said NHS 111 was “fundamentally a good idea” but had been badly implemented. He agreed with Dame Barbara that there were some areas where NHS 111 was performing well.

Asked the NHS England board meeting what sanctions that organisation could impose on failing providers, Dame Barbara said CCGs held their contracts.

She added: “I know in certain areas financial penalties have been bought into play, the problem is that doesn’t help patients get a better service. We have to measure the balance in continuing to support a provider and at the same time looking at an alternative.”

Readers' comments (11)

  • Andrew Craig

    It does work well in some areas. Find out which ones and what we can learn from them to spread good practice. Listen to what patients are saying about it on Patient Opinion and see how the providers are responding. Frightening the public about 111 can be left to the tabloids. The thought of NHS England believing it can "manage the market" for NHS 111 is unsettling. If you want to disincentivise good providers, that's the way to do it. And as for Mr Hunt's recent kite flying speech about GPs taking back responsibility for OOH ....

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  • I cant believe there are 211 separate contracts for NHS 111. Forgive my ignorance but surely there are lead CCG's. Whatever there was clearly no sense in rolling out this new scheme at the same time the CCG's were finding their feet, especially as there was an existing service which kind of worked. Will it be Dave or Babs who will get it in the neck for this fine mess?

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  • Speaking as a retired PCT executive, I can't see any reason for CCGs to be challenged over something that was put in place before their time.

    PCTs had their own concerns about the procurement. These varied from the bizarre arrangement that expected a national service to be commissioned through "n" hundred local contracts, to the unproven protocols built into the software, to the delayed reporting of the pilots, to the ignored lessons from the pilots, to the (in my view) unreasonable scoring priorities in the procurement which put quality at less value than money (when will the centre ever learn!).

    This leaves aside all the implications of a national roll-out to new providers who did not have a snowball in hell's chance of gearing up in the time available.

    Having retired, I now volunteer in my village as a community first responder, and we get anguished emails from the ambulance service to help bail them out, especially over bank holiday weekends... This was all entirely predictable, and actually entirely unnecessary. This could have been used as a way to engage CCGs in the management of the hospital front door (much needed right now) and instead it appears to be a massive shot in the foot.

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  • I'm fed up with hearing about how NHSD's 0845 number is supporting 111 to help with the demand!!!!
    Isn't that (NHSD) who is responsible for NHS111 in the 2 worst areas of the country, North West and Midlands, and they are failing miserably!!
    What about the local out of hours providers who quickly stepped back into the breach despite having most staff transferred out/made redundant because of this fiasco.
    NHSD is responsible for this mess in those areas yet all the press is about how they are being wonderful in propping up the service!!!! one word - JOKE!!!!!

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  • isn't there something called the Francis report that talks about a duty of candour? It seems only to be expected of the minions (like me) at the coal face of commissioning. Those at the centre of the mess seem keen to cover tracks. Is this the way to inspire a new generation of clinical commissioners?

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  • Blame, blame, blame. lets put our energy and effort into sorting it out. Its here, its a bit of a mess, we need it so lets get our heads together and sort it. i agree with suggestion above about looking at areas where it does work well and taking the learning

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  • 111 was meant to be an enabler for change in Unscheduled Care, but first you have to shine alight on it....
    The sad cases reported in the press over the weekend will have to go through due scrutiny, but at a first glance, the failure look to be in provider part of the system eg terminal care in particular.
    In the heat of debate we need to be clear what is failing - the Call Centres (i.e. 111) or the unscheduled provider responses (OOH, Ambulance, terminal care services etc...). It is likely to be both, but which is causing most distress and/or most harm remains to be seen.
    Regardless of the outcome of the review, if Unscheduled Care is in a better place for all of us at the end of the review, then 111 will have achieved one of its objectives.

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  • Bob Neilans

    How are terminal care patients even getting anywhere near 111? - A Palliative Care Co-ordination Centre (as in Lincolnshire), Hospice at Home or Rapid Response services (during the night) should be the routes for all terminal care patients - the last place a terminal care patient needs to be is A & E!!

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  • Martin Rathfelder

    When will we get to see the Deloitte report on this fiasco?

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  • Bob Neilans

    How are terminal care patients even getting anywhere near 111? - A Palliative Care Co-ordination Centre (as in Lincolnshire), Hospice at Home or Rapid Response services (during the night) should be the routes for all terminal care patients - the last place a terminal care patient needs to be is A & E!!

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  • There are 44 contracts for NHS 111 on the Easter report - covering populations of 138k (Isle of Wight) to 5.8m Yorks and Humbs.

    Q for 3.24 - please can you share your data - I can't see any comparisons on line by contract except over Easter. The Easter data shows the worst performers (number of times in the bottom 20% of performance) to be Notts, Northants, Wilts, Bristol (BNSSG), Kent Surrey Sussex, Dorset.

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