Doctor’s fear for NHS Direct replacement

A 24-hour patient helpline being trialled by the Department of Health to replace NHS Direct has led to more ambulance callouts and potentially lowered the standard of care for children, doctors claim.

Although some private sector firms have refused to bid for the contract, feeling it is unworkable, the Department of Health plans an April 2013 launch for the national 111 service – a free one-stop number for patients with urgent, but not life-threatening symptoms.

The helpline is being organised with local franchises, but Capita, one of the biggest government providers, has pulled out from tendering, saying it had not been “constructed in a manner that will result in cost effective services”.

NHS Direct employs more than 3,000 staff, 40% of whom are trained nurses, but the replacement will be staffed by call handlers, who will have as little as six weeks’ training. This lack of medically trained staff will lead to more referrals and poorer outcomes, especially for vulnerable patients, say doctors.

The British Medical Association’s conference of family doctors last week passed a resolution saying GPs had “serious concerns about the design and precipitous introduction of the 111 model” and that the “government is ignoring the lessons from evaluations of 111 pilot schemes”.

Mary McCarthy, a GP from Shropshire who is part of a doctors’ co-operative Shropdoc, said the first four pilot schemes showed that ambulance dispatch rates were three times as high in these areas. “That’s treble the costs. Also, we see evidence of poorer care to children.”

She said some children who should be seen by a doctor were not getting help. “You get good outcomes when systems are clinically triaged with a medical professional or medically trained person dealing with patients. Not when you work to a computer algorithm where a lot of patients don’t fit into a flowchart. Children, older patients, mental health … it does not work.”

The government said a full evaluation of the pilot would be published later this year. The health minister, Paul Burstow, said: “NHS 111 is being introduced to make it easier for people to get the healthcare advice they need or to get to the right healthcare service first time – 24 hours a day, 365 days a year.

“Local NHS organisations are working with GPs and other clinical professionals to decide who should provide their local 111 service. Providers could be ambulance trusts, groups of GPs, NHS Direct or private providers – whoever will give the best service for patients and the best value for money for the taxpayer.

“NHS 111 call advisers have to complete a six-week training programme which is exactly the same training as 999 operators. They are supported by nurses who work alongside them in the call centres, and nurses will always be on hand to take over if the caller needs to speak to someone with clinical skills.”