NHS helpline is ‘increasing strain on A&E’, say Sheffield researchers

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The new NHS 111 telephone helpline has increased strain on ambulances and A&E wards despite being set up to reduce pressure on urgent healthcare services, according to Sheffield researchers.

A report by academics from Sheffield University’s School of Health and Related Research has found that tens of thousands more ambulance call-outs could have been triggered by call handlers without medical expertise ‘erring on the side of caution’.

Janette Turner, who led the research team, said the results indicate NHS 111 is ‘creating rather than curbing demand’.

In Sheffield, the full launch of the helpline was delayed for three months earlier this year after city health chiefs expressed concerns over the system’s safety, while NHS medical director Sir Bruce Keogh has announced a major revamp of the service.

The free number is for patients with non-life-threatening symptoms who need help rapidly, and was intended to replace the old NHS Direct service, GP out-of-hours numbers and the handling of urgent dental calls.

Trained advisers who answer phones offer basic health advice and direct the caller to the most appropriate service, such as hospital or an on-call doctor.

The university project was commissioned by the Department of Health to evaluate the ‘use and impact’ of NHS 111.

Researchers analysed 36 months’ worth of data from four pilot call centres, as well as three other sites, covering ambulance call-outs, A&E attendances, contact with out-of-hours services and calls to NHS Direct.

During the first year of operation at the pilot centres, more than 400,000 calls were made to 111, of which just over 277,000 were triaged using a system called NHS Pathways. Of the triaged calls, 28 per cent were referred to a nurse for clinical advice, and over half were deemed to require primary or urgent care services.

Emergency ambulance incidents rose by just under three per cent at the pilot sites - equivalent to an extra 24 incidents per 1,000 triaged calls - each month, equivalent to an additional 14,500 call-outs per year. Urgent care activity rose by between five and 12 per cent.

Ms Turner said: “It is probably unrealistic to expect any one service to do everything, and real improvements may only be gained when a series of co-ordinated measures designed to increase efficiency across all services are implemented.

“The provision of a single point of telephone service that quickly guides people needing urgent care advice to the most appropriate service is sensible, given the public’s confusion about which service to access.

“NHS 111 also offers an easily remembered number, with an emphasis on fast triage and smooth transfer to ‘the right service first time’, all of which patients say they want.”

The report was published by the British Medical Journal.

NHS England says the helpline’s overhaul will see it redesigned to ‘definitively manage’ patients’ problems rather than simply providing advice.

Call handlers will be able to directly book GP appointments, as well as see patients’ medical records, and there will also be more opportunities for callers to speak directly to medics.

The revamp is part of a raft of measures announced by Sir Bruce Keogh to ease pressure on emergency health services.

Under the plans, a shake-up of A&E units would see the biggest 40 to 70 units – likely to include Sheffield’s emergency ward at the Northern General Hospital - designated major emergency centres, and dealing with illnesses such as heart attacks, strokes and trauma.

The remaining 70 to 100 A&Es would deal with less serious conditions.