NHS Direct has experienced a significant and consistent drop in calls to its national 0845 number since 2006, HSJ can reveal.

Calls to the flagship 0845 service were consistently lower month-on-month in 2007 than in 2006, with the exception of November and December when they held steady. In April 2006, the service received 456,000 calls but only 402,000 a year later.

In the period April to December 2007, the number of callers was 7 per cent down overall compared with 2006.

The figures show an even bigger gap between expectations and the actual number of calls.

Board papers from 5 February forecast 8.2 million calls to all its services in 2007-08, including 0845, out of hours, choose and book and other contracted services - down 2.6 million on its budgeted expectations of 10.8 million calls at the start of the financial year.

The budget sheet shows that this will push the direct service costs per call up from£7.35 per call to£8.46 - an increase rounded down to£1.10 per call.

A spokesperson said the drop in calls to the 0845 number reflected the rise in the number of people using NHS Direct's website, which has been heavily promoted and now gets around three million hits a month.

He said: "It is not a concern to us, as we know that we are getting a lot more people accessing our services.That's not to say we are happy and we will be addressing this drop by raising awareness and letting people know they can ring."

The drop did not affect NHS Direct's income, as the 0845 service operates on a block contract worth£150m a year from the Department of Health, he added.

The board papers reported the service had consistently answered 98 per cent of calls each month in 2007, compared with 89 per cent in 2006.

The figures come as NHS Direct consults on its plan to become a foundation trust.

Chief executive Matt Tee has already mooted a new service in which NHS Direct could get extra money for calling to people with long-term conditions.

Work is already under way to develop this. A pilot programme offering telephone health advice to 2,000 people with long-term conditions in the West Midlands is set to expand to cover 11,000 by April 2009, after it showed a 30 per cent reduction in GP use and 50 per cent reduction in emergency admissions.

NHS Direct is a partner in this scheme with Birmingham East and North primary care trust and Pfizer Health Solutions.

A tender issued earlier this year has drawn interest from 18 potential partners interested in developing long-term condition programmes.

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