The current pressure on A&E services is very much in the media’s election-fevered mind, and while there are many reasons for this additional pressure I wonder if in part at least NHS 111 has something to do with it.
NHS 111 services presumably deliver the defined benefits as identified when the tender process to outsource the services were initiated. That may be a naive assumption – but I’m going to make it nonetheless. I’m also going to assume that the intention of the 111 service is/was to alleviate demand on GP and/or A&E services by providing an alternative advice/triage service to, as much as anything else, filter emergencies and non-emergencies.
However, the introduction of a protocol-lead triaging system (as opposed to a purely clinically-lead one) may have derived benefits in dealing with a lot of routine questions, but by its very nature such a protocol-lead service needs to be wholly risk-adverse, and err on the side of caution. This in turn may well have introduced a dis-benefit of the service, by resulting in too many ‘default’ referrals to A&E which may have been avoided had the callers been able to make appointments to see their GPs (a purely clinician-lead service).
To remove this disbenefit (assuming it does exist), 111 services would ideally need to be re-procured, ensuring a revised specification includes measures to compensate for the bias to refer too easily to A&E services. It may be that the services require more clinical input than at present, but, while that may make the services more expensive to re-procure, the investment could well result in savings in avoided A&E attendance, which on a per-capita basis are more expensive in clinician time and effort, let alone the adverse pressure they add to the system as a whole, as illustrated at the moment.
My observations were recently further backed up by the anecdotal experience of a friend who, after contacting her 111 service for advice about a sore throat found herself triaged by the service as a possible heart attack, resulting in a trip to A&E from which she emerged, after 12 hours and a barrage of expensive tests with an antibiotics prescription for guess what? – a sore throat.
