NHS 111 switch will be a 'big bang'
NHS 111 is likely to generate inappropriate referrals for a “considerable period of time”, a champion of the new non-emergency telephone number has told HSJ.
With less than four months to go until the new non-emergency number is due to go live across England, areas that have already introduced the system are seeing an increase in demand on emergency services.
Simon Featherstone, chief executive of North East Ambulance Service Foundation Trust which led on the first pilot, said this was to be expected while the system developed new services.
“NHS 111 is a long term journey… there is going to be a lot of inappropriate referrals for a considerable period of time until the rest of the system, particularly services we need to develop outside of hospital, are ready to accept patients…The whole system needs to be built around this.”
The issue is explored in more detail in this week’s HSJ Briefing, analysing the rollout of NHS 111.
The North East Ambulance Service worked with the Department of Health on the development of NHS Pathways, software that can used by non-clinical staff to conduct a detailed triage of callers. It uses a directory of services, populated by local commissioners, to identify the most appropriate service from A&E to self care.
By collecting data on where gaps in service provision exists through Pathways, Mr Featherstone expects NHS 111 to allow the decommissioning of some hospital services as alternatives are set up in the community.
However, John Horrocks, chief executive of Urgent Health UK which represents social enterprise out-of-hours providers, said in many places the directory of services was not being treated with sufficient importance.
“It’s the responsibility of commissioners to maintain the directory of services; the problem is they’re all over the place due to the reforms,” he said. “In a lot of areas the directory feels like it’s falling through the cracks a bit and is often treated as an administrative task.”
So far 42 out of 44 contracts have been awarded. There are currently only 10 areas of the country live and reporting into the DH minimum data set.
NHS Direct chief executive Nick Chapman told HSJ the switchover is “much more of a big bang than we would have liked”.
He said: “Any slippage of mobilisation would give rise to problems. We are being asked to provide contingency support in the event of problems; we’re planning for the worst but hoping for the best.”
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Readers' comments (5)
Anonymous | 27-Nov-2012 1:07 pm
...inappropriate referrals and increased demand for emergency services for a considerable period of time...how will this sit with QIPP plans, CCG and quality premiums for reducing inappropriate referrals and emergency admissions? What is the long term aim/value of 111, and is it really worth it?
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Patrick Newman | 27-Nov-2012 1:47 pm
Bad news for East of England Ambulance Service who are subject to criticism following a controversial rationalisation - at least in the short/medium term. For it to succeed patients must value the 111 service and need to be properly informed of its introduction - fat chance.
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Anonymous | 27-Nov-2012 3:28 pm
This would have fitted perfectly with QIPP had it been introduced in year 1, not year 3. 'Invest to save' was only affordable at the beginning of the 5 year plans but in general even then SHAs did not encourage that kind of far sighted behaviour - or did not have scope themselves to allow and enable it. No wonder Jim walked, the DH paid lip service to quality leading the way for savings, then made everyone operate cost improvement, not QIPP, to land on the money every year end.
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Anonymous | 29-Nov-2012 1:02 pm
Disagree with 3:28. There would always have been (and continue to be) extra load on the rest of the system as a result of 111.
This could easily have been foreseen by simply looking at triage arrangements in Out of Hours/Urgent Care centres where theis work is done by non-medical staff.
The systems ALWAYS err on the side of caution. This then results in an increased referral burden.
What isn't always appreciated is that this "safe" approach actually makes it harder for doctors to see what really is urgent as you get the highest rated tiers of the triage scale clogged up by people who shouldn't be there but ended up there as a result of their responses to red flag questions.
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Anonymous | 30-Nov-2012 1:24 pm
One thing that needs to be considered about the impact of NHS 111 it has come at a time when we going through one of the largest NHS reorganisations of all time. Therefore commissioners have not been able to consider how NHS 111 integrates into local urgent care systems. Given time the service will be of massive benefit for patients but it needs to be part of wider improvements to urgent care systems and not seen as the silver bullet.
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