It is now more than a month since the BMA first blew the whistle on the gathering failures bedevilling the government’s flagship NHS 111 service—and regrettably the problems show no sign of abating. In many areas of the country, such as Greater Manchester, NHS 111 was overwhelmed by call demand during its pilot phase before Easter to such an extent that it was suspended before it had even been launched. Similar problems hit the service in South London and in other regions, forcing suspensions or part suspensions of NHS 111 as Easter came and went. Where it was operational NHS 111 limped towards the May bank holiday with little sign of improvement.
So how and why did it come to this?
The BMA, like many doctors, supports the principle behind the idea of a non emergency triage number for patients to call. In theory, this could help tackle health queries that do not necessarily need a patient to visit a GP surgery, A&E unit, or other NHS service, and by extension relieve pressure on a health service that is facing a rising workload and contracting resources.
But, as the BMA has repeatedly warned, the implementation of this idea has been undermined by an ill thought out roll out that ignored clear warnings in the rush to a launch.
It was clear from the start that any non emergency number would incur high call demand yet doubts emerged rapidly as to whether enough call operators were recruited. This has resulted in widespread reports of patients being unable to get through to an operator, or waiting hours before getting a call back with the health information they requested. In some areas, such as Manchester, NHS 111 effectively crashed because it was unable to cope with the number of calls it was receiving. This is a serious worry from a patient safety angle as if an individual has any form of concern about their health they must be able to get hold of first class advice straight away. Introducing any form of time lag puts the patient at risk.
There has also been concern about the quality of advice being relayed through some of the call operators. As well as adding another worrying element of risk to the process, it can also result in a potential waste of NHS resources if, as has been reported, an ambulance is sent out to someone with an ingrowing toenail, or for other calls that clearly do not require immediate medical attention. This only adds to the burden on the NHS and completely reverses the reason for setting up the system in the first place, a situation that has been further compounded by the fact that ambulance services, GPs, and other parts of the NHS have often had to pick up the workload in instances where NHS 111 has ground to a halt.
Unsurprisingly patients are not impressed, and neither are GPs. A local medical committee in the North East of England did a survey of its members recently, and it showed more than 60% of GPs said their experience of the service had been poor, and more than 80% said it had contributed to a worsening of out of hours services. Dr Malcolm Kendrick describes it very succinctly in his blog, “it is the type of nightmare bureaucrat driven nonsense that is turning healthcare in the UK from something local, flexible, and responsive to patient needs, into a flabby form filling, algorithm following exercise.”
I couldn’t have put it better myself. In short, NHS 111 is an example of a good idea that has been undermined by a failure to heed advice and sort out the practicalities before rushing ahead to a launch that was simply unnecessary. For the timebeing the system continues to stumble forward in what the authorities have admitted is a “fragile state.” The BMA’s bottom line is that any evidence that a local NHS 111 service is unsafe or failing to deliver an adequate service should be met with its immediate suspension and not more empty promises that NHS 111 is on the mend.
Kailash Chand has been a GP for last 30 years. He is deputy chair of the BMA council and he was on the general practitioner’s committee. He was awarded an OBE in 2010 for services to the NHS. The views he expresses in his blog posts are entirely his own.