Viewpoint: NHS 111 should be scrapped

NHS 111 is not fit for purpose and creates inappropriate work for GPs and A&E, says Dr Saqib Anwar.

NHS 111 has failed and should be scrapped. It was an ill planned and ill-conceived political creation that in my mind is not fit for purpose.

While there were many concerns that were expressed at its inception the political will was such that it unfortunately fell on deaf ears. The 111 service which, on the whole, is staffed by non-clinically trained operators has resulted in a risk-averse triage system that has put unnecessary pressure on already strained A&E and GP services.

I have seen significant increases in volume of inappropriate work being directed towards GPs and A&E by 111.  While the intentions may have been noble the service in my mind is an additional needless barrier that exists between patients and their ability to receive proper and timely care. 

What is wrong with NHS 111?

So what is actually wrong with the service? Firstly, any system that is designed and centred around non clicnians entering data into pre-agreed computerised pathways for issues as serious and complicated as health is naturally going to be fraught with difficulties.

Humans and their illnesses are complex and to think that a non-clinical person, through series of negative and positive questions, would be properly able to contextualise and advice the patient is, to put it bluntly, beggars belief.  

As a clinician I know that problems and people do not fit nicely into pre-defined silos of classical presentation and so the fail safe in all of this will inevitably be to see a GP or seek health advice from a healthcare specialist. 

The second problem is the staffing and support structures of 111 providers are not uniform and so the experience for patients is certainly not uniform. It very much results in a postcode lottery and further enhances the health service inequality within the NHS.  

It is fair to say that some providers have really struggled to provide adequate levels of clinical cover to their call handlers and this in itself poses a major safety risk and concern. If I would not happy for my family to be using this service then why do I accept it for my patients?

Doctors have a moral, professional and ethical duty to stand up and speak especially where they feel that patient care is being compromised. Through 111 ineffective and inappropriate use of healthcare resource is being allowed to continue unchecked all in an environment where resource and funding are sacrosanct.  

Discharge paperwork

The third problem with NHS 111 has to be the reams and reams of paper that they generate as supposed discharge summaries for patients that have called the service. GPs who have multiple constraints on their time already are subject to pages and pages of protolised negative responses and often struggle to find the reason for the persons contact.

No one seems to want to address this broken facet of the 111 journey, and many GPs are resigned to accept this as the norm.

The fourth problem is the additional layer that NHS 111 creates. For some patients this means rehearsing their story potentially four times before they can finally receive treatment for their problem.

The journey starts with a call handler, who passes to a nurse who states that need to speak to a doctor, who then arranges for visit to the patient. As a visiting clinician I am usually the third if not fourth person the patient or their representative may have spoken to that day and is it surprising that they are a little annoyed?

While the idea of a unified number for non-emergencies is welcomed by patients and users of the service, the reality on the ground is that is not working for anyone. The current system is unsafe and fundamentally flawed and patients deserve better. In its current form we should all be calling for an end to this less than optimal service. 

  • Dr Saqib Anwar is medical secretary of Leicester, Leicestershire & Rutland LMC

Picture: Pete Hill

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