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Emergency services feel strain of telephone trial

A telephone triage system developed by Connecting for Health to direct patients to the most appropriate forms of care appears to be increasing pressure on emergency services, HSJ has discovered.

NHS Pathways involves the collection of detailed information about the patient, their clinical need and its urgency. An algorithm is used to match them to services available locally.

It is one of only three clinical assessment tools approved by the Department of Health for use in the new NHS 111 service and is expected to be used by the majority of providers of the non-emergency telephone number, as well as by most ambulance trusts for 999 calls.

North East Ambulance Service Foundation Trust, the first pilot site for NHS 111, has been using Pathways since 2006. However, the three major ambulance trusts that have introduced the NHS Pathways system since March 2011 have seen a rise in the number of calls classified as category A - the most serious, life-threatening cases.

South West Ambulance Service Foundation Trust saw the proportion of calls classified as category A calls jump from 23 per cent during 2010-11 to 36 per cent in the first quarter of 2011-12 following the introduction of pathways in March 2011. In June this year the figure was 32.5 per cent.

DH data shows South East Coast Ambulance Service Foundation Trust and West Midlands Ambulance Service Trust also saw steep rises in the number of category A calls after the system was introduced, the former with an increase of 13 per cent in the year to June and the latter a 20 per cent rise.

Ambulance trusts that have not introduced NHS Pathways saw a 6.5 per cent increase over the same period. Peter Bradley, DH national ambulance director, said: “One of the perceived benefits of pathways was they would end up with a lot less category A calls. That’s not been the case.” However, he insisted the system had identified alternative to traditional ambulance responses.

A report to South West Ambulance Service’s board in July said calls to its out-of-hours GP service were being classified by Pathways as urgent when it would have been clinically appropriate to downgrade them. This was blamed for an increase of 20-25 patients a day attending Royal Cornwall Hospitals Trust’s emergency department.

However, a spokeswoman for the DH said there was “no evidence” Pathways was increasing demand on emergency services. She added: “All aspects of the system are based on the latest clinical evidence and practice and any proposed changes are considered and agreed by this independent group.”

Readers' comments (6)

  • Couldn't find the SWAT report on their website. The numbers would be very interesting to look at.

    Unsuitable or offensive?

  • Couldn't find the SWAT report on their website. The numbers would be very interesting to look at.

    Unsuitable or offensive?

  • Hi Anons,

    I've attached the report to the story, the relevant parts are on page 10 and page 28.

    Hope that's useful,


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  • There is surely no surprise here. Does anyone know how many NHS direct calls about sick children result in advice to see a clinician? Just another layer of apparent access that is another layer of cost without any evidence of value. If I practiced medicine the way some management decision are made, I would have to explain myself to someone very important. I bet that this access initiative sits in a CV as another success story...

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  • Couldn't agree more with the above. Layer upon layer of expensive uselessness. In a very recent example, antibiotics were needed on a Saturday for a bladder infection in someone with a long-term condition (who had been instructed by GP to NEVER leave such a situation unattended over a weekend due to the ltc). It took nearly six hours to get a prescription; this was after no less than five different telephone conversations with five different people, each one answering an identical set of 'triage' questions and each one delivering down the phone to the patient the most patronising set of instructions for self-care ever received. That the patient had forgotten more about these situations than the call centre operators would or could ever hope to get to grips with is - it seems - acadmic: instead we simply must spend all this money and waste everyone's time (and prolong the length of the infection thus increasing the risk of complications, anyone?) for categorically no benefit whatsoever. Oh and by the way, all five contact points had access to - and referred to - the patient's GP records. Who said they could have that? But's that a whole other story .....

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  • Re the comment about uneeded child referals from NHSD to the GP. Yes there are quite a few, bit thats nothing compared to the amount that are downgraded to self care. We live in a society where it is deemed necessery to call someone becuase little Johnny has a temp of 37.9 for 1 hour and the parent hasn't tried paracetamol and plenty of fluids. Telephone triage will always err on the side of caution and sort higher, thats life. The point of this artical, and what ervryone has known from day one, is pathways triages far too high and as soon as the Shefield report comes out this will be proven.

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