NHS England has “lost” time exploring the use of GPs for the NHS 111 phone line as there are too few in the workforce to support it, a leading clinician working on the development of the service has said.
Instead, NHS England medical adviser Dr Ossie Rawstone has urged commissioners to consider how they could use the existing NHS 111 workforce, including the clinical expertise of nurses working on the non-emergency phone line.
Speaking at the Urgent Health UK conference in Birmingham yesterday, Dr Rawstone said pilots trialling a greater role for GPs in 111 services had been positive. They had seen an increasing proportion of patients managed with self-care and fewer referred to accident and emergency departments.
However, he said current shortages of GPs meant providers would struggle to roll out the model.
“The difficulty is if you’re building a model where you’re putting all of the calls through a GP triage process it carries with it the corollary that we need to find a workforce to do that,” he said.
He added: “I think it was always a little bit naive to think that even if we wanted to do it we could… we have lost a bit of time.”
Since its launch in April 2013, NHS 111 has faced criticisms that it is risk averse and increases pressures on other parts of the system, leading to unnecessary ambulance callouts and attendances at accident and emergency departments.
NHS England has led work to improve the service when existing contracts are reprocured.
Almost a third of these contracts must be let by September next year and many clinical commissioning groups have already begun to think about how to procure them.
Eight pilots were launched earlier this year following meetings with providers and commissioners at which some groups called for greater GP involvement.
They trialled approaches including GPs walking the floor in call centres and earlier clinical involvement for calls reporting certain symptoms, such as chest pain, which tend to see ambulances dispatched unnecessarily.
An evaluation of these pilots is due to be published in the next few weeks.
Yesterday Mr Rawstone revealed a second phase of pilots, due to begin later this year, would look at improving the effectiveness of the existing workforce.
The GP and former ambulance trust medical director told delegates a key ambition was to work out how more complex patients could be identified more quickly by call handlers using the NHS Pathways telephone triage software.
He said currently many of these patients were passed around the system.
“There are quite a lot of patients who I think [NHS Pathways] works really well for… I think there’s quite a big proportion of patients that’s really difficult to put through an algorithm successfully, particularly complex patients,” he said.
“The difficulty is finding how big that group is and identifying them.”
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