NHS 111 should be scrapped – GPs

NHS 111 should be “scrapped” in its current form, GP leaders have said.

Sue Roberts, a Somerset-based GP, proposed a motion to scrap NHS 111 the BMA local medical committees conference last week. She said the non-urgent care telephone service “doesn’t work”, citing a rise in referrals to general practice and A&E and a drop in self-care advice from 48% to 15%.

Roberts’ motion consisted of several parts, including the potential for it to be re-commissioned as a local service, to be fully integrated with unscheduled care providers or to be based on early skilled clinical triage.

Conference attendees voted overwhelmingly in favour of the main point of getting rid of the service but did not support any of the alternative options mentioned in the motion.

Roberts criticised NHS 111’s “shipwreck of a triage system”, which sees non-clinical staff use a computer algorithm to determine what advice to give to a caller.

She said this results in a “risk-averse triage system” that means patients get sent ambulances when they don’t need them.

“We should just get it right first time and the obvious answer to this is to have triage integrated with the unscheduled care providers, with clinicians at the frontline,” she said.

Despite the worries of doctors, there are no plans to drastically overhaul the service.

In a comment to Digital Health News, a spokesperson for NHS England said: “diverting over 10 million patient calls a year from 111 to GP surgeries would make no sense at all for either patients or GPs themselves.

“The answer instead is to better integrate GP out of hours services, 111, and ambulance calls into a streamlined NHS "urgent care front door", which is what’s now happening."

These plans included closer integration with online service NHS Choices, with proposals on how this can be done to be published in September 2015.

Also speaking as part of the conference motion was Faye Wilson, ex-chair of the LMCs, who suggested the service be scrapped outright without considering the alternatives suggest in the motion.

“Like communism NHS 111 is a great idea, but disappointing in practice,” she told the audience.

“NHS 111 is a basic tool we didn’t need because we already had something better. It just gets in the way and is a barrier between a patient and their care.

“It’s not an unmitigated disaster because we have put in mitigations. But it’s a terrible lost opportunity and a waste”.

BMA GPs committee chair Chaand Nagpaul, said earlier in the day that a “complete overhaul” of NHS 111 was required, due to the extra referrals to GP practices “clogging up our appointments”.

“This comes as no surprise with a system relying on computer algorithms – not clinicians – to give advice.”

The Royal College of General Practitioners is working on several pilots involving the use of GPs as part of the service, with early evidence suggesting that the addition of clinical support can cut the number of ambulance call-outs by two-thirds.