25 October 2012

NHS 111 - a mixed start but potential for the future

An evaluation of the new NHS 111 telephone service, conducted by researchers from the University of Sheffield, shows pilot schemes have delivered some but not all of the potential benefits one year after they were launched.

Academics from the University's School of Health and Related Research (ScHARR) issued a report to the Department of Health evaluating the new 24-hour telephone service, which is designed to help people access appropriate healthcare for urgent medical problems. The service is free to use and aims to direct callers to the right service, first time.

The study found that the new service has been well used, is liked by the people that use it, and has potential for the future. However researchers highlighted two main areas of concern:

• The pilot schemes have not delivered some of the expected benefits by improving public perceptions of urgent care or reducing unnecessary emergency ambulance journeys and emergency department visits. There was evidence of an increase in use of emergency ambulances.
• There is a need to review some of the call assessment processes, particularly for referrals to 999 ambulance services.

The team of researchers, led by Janette Turner from the University of Sheffield's Medical Care Research Unit, measured activity in four pilot sites – one ambulance service provided site and three NHS Direct provided sites –to assess the extent to which the service was a useful and cost effective addition to the emergency and urgent care system in England.

In its first year more than 353,000 calls were answered by NHS 111 and 80 per cent of these were triaged. All four pilot schemes met national quality standards for abandoned calls and proportion of calls answered within 30 seconds.

A total of 872 people who had used NHS 111 took part in a survey nine months after the services started, with 73 per cent of users rating their overall satisfaction with NHS 111 as very good.

A large proportion of respondents (85 per cent) indicated that they complied with all of the advice given during their telephone call, 65 per cent said the advice was very helpful and the majority of callers appeared to have been directed to the right service. Satisfaction levels were lower for some aspects of the service, in particular the relevance of questions asked and advice given.

In the pilot services NHS 111 was an additional service and as such is unlikely to be cost effective. However the intention is to provide a national service which replaces NHS Direct and GP out of hours call handling and this national service has the potential to save the NHS money although this will be dependent on the ability of the new service to cope with increased numbers and different types of calls.

Lead researcher, Janette Turner, said: "The evaluation has shown a well performing service, as well as ways of improving the assessment. This is a new service that has only been running for a year and the lack of impact of NHS 111 in the wider health service could be explained by the relatively small number of calls compared to national demand for emergency and urgent care or the fact that the pilot services are at an early stage of development. However, it cannot be assumed that increased use, and time, will produce expected benefits.

"Further consideration is needed to reviewing call assessments, particularly those resulting in the need for an emergency ambulance, integration with other services and how the service will deal with increased and probably different demand if it replaces NHS Direct."

NHS 111, which was set to be launched nationally in April 2013, has come under huge scrutiny - with GPs calling for its roll-out across the country to be delayed. Consequently the Department of Health announced in June that regional areas would be given more time to introduce the service although only four areas have requested extra time.

To view the report in full visit http://www.sheffield.ac.uk/scharr/sections/hsr/mcru/111