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NHS 111 and GPs' on-call services

It is important for NHS 111 to integrate with existing urgent care services, says Dr Brian Gaffney.

NHS Direct call centre: values GP out-of-hours services (Photograph: NHS Direct)
NHS Direct call centre: values GP out-of-hours services (Photograph: NHS Direct)

The aim of the NHS 111 service is to help local people across England get a quick and effective response to their urgent, non-emergency healthcare needs.

It is extremely important that patients see NHS 111 as their local service, and this will only be possible if we can work in an integrated and joined-up way with the organisations that currently serve their local communities.

I read in a recent edition of GP that GP leaders are worried that cost-cutting and competitive tendering could force GP-led out-of-hours providers out of business.

But I can speak for NHS Direct when I say that we value the experience and credibility of local GP out-of-hours and ambulance services and believe they are key to the success of NHS 111.

Strong partnerships
NHS Direct has already established strong partnerships with commissioners and local providers while working on the current NHS 111 pilots.

As the national service is rolled out we are committed to continuing to develop partnership arrangements with GP out-of-hours organisations and ambulance trusts.

This has the support of the DoH. It has confirmed that NHS Direct will work with GP out-of-hours organisations and ambulance trusts to agree a plan for delivering the NHS 111 service specification in areas where a go-live date for piloting or procurement has not been agreed by 23 September 2011.

Discussion and engagement at this stage are hugely important so that we know where the different organisational strengths lie, and so that we can work together to complement each other's capabilities.

NHS Direct is using its experience over the past 12 years of providing remote assessment and services over the telephone and the web at large scale, as well as our robust clinical governance procedures, to ensure that NHS 111 is high quality and cost-effective, and maximises self-care where appropriate.

We also have trained and experienced health advisers and nurses currently delivering the 0845 service. More than 150 of these staff have already been trained to deliver NHS 111 and there will be more trained staff as further pilot schemes become available in other parts of the country.

NHS 111 will only be successful if it is built on an effective urgent and emergency care system. In some cases, this may require redesign of local services to ensure that critical services, such as A&E, are only used where appropriate and there is a range of suitable alternatives in place.

Self-care channels
More people now access NHS Direct's services via the web than they do by telephone, so we know a drive towards self-care and self-serve channels is important in managing demand and responding to changing patterns in how the public accesses healthcare.

We have experienced a partnership approach in the NHS 111 pilots we are involved in delivering. In Nottingham City, Lincolnshire and Luton, NHS Direct's health advisers, supported by nurses, answer and triage NHS 111 calls.

The various options are to:

  • Immediately transfer the call to one of our nurse or health information advisers for further self-care advice.
  • Refer the call to face-to-face services using a comprehensive directory of local services that has been developed locally.
  • If out-of-hours, we can book an appointment with the GP out-of-hours provider. Or in an emergency, we can get an ambulance dispatched.

In the pilot running in County Durham and Darlington, the North East Ambulance Service is leading on delivery and we are working closely with it to provide health information advice to non-symptomatic callers.

NHS Direct is already having constructive potential partnership meetings with GP out-of-hours providers and ambulance trusts in many areas, and to complement this work, we are arranging open days in the coming months so that GPs and others involved in the delivery of NHS 111 can visit the pilot sites and see first-hand how the service is working.

  • Dr Gaffney is a GP in Northern Ireland and medical director of NHS Direct

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