Published: 31/01/2002, Volume II2, No. 5790 Page 8

The continued expansion of NHS Direct must be supported by a sensitive staffing strategy or risk hitting nurse recruitment across the rest of the NHS, the National Audit Office has warned.

NHS Direct is now the world's largest provider of healthcare advice over the telephone, handling 7.5 million calls a year, according to the study published by the NAO last week, but there are ambitious plans for a further expansion of the services it provides.

Although the implementation of NHS Direct has been a success and it has reduced demands on other parts of the NHS, the strategy for broadening and extending coverage, integrating with GP out-of-hours services and taking on new responsibilities, needs careful management, the report says.

NHS Direct currently employs 0.4 per cent of all full-time equivalent qualified nurses in the NHS, with 20 per cent of its nursing workforce coming from outside the NHS.

The NAO says the service has adopted a range of measures to minimise the impact of recruitment on other parts of the NHS, including nurses working part-time for both NHS Direct and the NHS. 'Staff vacancy levels vary among sites, however, and there will be further pressure on recruitment if the increase in staffing levels necessary to meet projected rapid increase in takeup of NHS Direct services is to be achieved, ' the study concludes.

The service, launched in November 1998, has already met its target for 60 per cent of the population to be aware of NHS Direct by March 2002. But it concedes that younger people, those over 65, ethnic minorities, people with disabilities and 'less advantaged social groups' were either less aware of NHS Direct or used it less although their need for the service was greater.

Despite initial teething troubles, which generated hostile media coverage, public satisfaction with the service is 'consistently very high at over 90 per cent' and this is reflected in 'very few adverse incidents'.

The NAO goes on to note that although capacity is being increased, there is scope for increasing the number of calls handled per nurse across callreceiving sites. It recommends that NHS Direct and the Department of Health should build on current successes by strengthening senior management to provide further direction and prioritisation.

Head of the NAO Sir John Bourne said: 'It was a terrific achievement getting NHS Direct up and running in less than three years. The challenge now for NHS Direct is to meet the expected increase in demand from callers and to set a clear future direction for the service.'

NHS chief executive Nigel Crisp, who described the report as 'a terrific tribute to the staff ', will appear before the Commons public accounts committe on 6 February to give evidence about the report. The DoH has said it will be considering the report's recommendations over the next few months.