BMA claims GP work from NHS 111 tripled in 12 months

The number of calls referred to GP practices and A&E departments by NHS 111 services has almost tripled over the past year, according to a BMA analysis, but NHS England has questioned the claims.

Dr Charlotte Jones: warning over unnecessary work for GPs (Photo: Ray Farley)
Dr Charlotte Jones: warning over unnecessary work for GPs (Photo: Ray Farley)

GP leaders said the huge increase in volume of work being directed towards GPs and A&E by the NHS call-handling service was piling unnecessary work onto already struggling primary care services.

BMA leaders hit out at anecdotal reports from GPs that NHS 111 services were advising patients to visit GP practices with minor complaints such as 'colds, sore thumbs or other conditions that could have been treated safely by sensible advice over the phone'.

The number of calls referred to GP practices by NHS 111 rose 186% between January to October 2013 and the same period in 2014, according to an analysis of NHS England data conducted by the BMA.

However, NHS England has questioned the figures, warning that the BMA had misinterpreted its data.

5m extra calls

According to the BMA, the number of calls referred to GP practices by NHS 111 leapt from 2,844,452 between January and October 2013 to 8,138,863 calls for the same period in 2014, meaning GP practices were forced to absorb more than 5m extra cases.

Meanwhile calls referred to A&E by NHS 111 rose 192%, from 374,506 to 1,092,967 over the same period, the BMA claims.

The BMA cited figures from the Primary Care Foundation that suggest the proportion of calls to NHS 111 coded as 'self-care', in which the patient can safely treat their own condition after advice on the phone had fallen from 48% in 2012 to 15% in 2013 and 2014.

But a spokesman for NHS England said that the figures cited by the BMA were cumulative totals for calls referred from NHS 111 to GP practices. It says that the service had passed on 2,844,452 calls by October 2013, and 8,138,863 by October 2014. This would mean that the total increase in calls referred to GPs was 86% between October 2013 and October 2014.

GPC lead on NHS 111 Dr Charlotte Jones said: 'The BMA has consistently highlighted serious concerns about NHS 111. Before it was launched in March 2013, the GPC warned that it would struggle to cope with demand, a prediction that proved to be correct when large parts of the system collapsed immediately after it opened.

Doubts over clinical necessity

'This analysis of referrals over the past two years demonstrates that there has been a huge increase in the number of people put through to key parts of the NHS such as A&E and general practice. There is no doubt that if a patient needs any form of medical care they should be referred through to an appropriate doctor or nurse, but there are serious doubts as to whether this huge increase in workload is clinically necessary.

'Anecdotally, GPs have reported to the BMA that patients have been referred to them with colds, sore thumbs or other conditions that could have been treated safely by sensible advice over the phone.

'The NHS cannot afford to have unnecessary workload being created. GP practices are already struggling to deliver enough appointments to their patients as demand rises, resources fall and staff shortages continue to undermine GP services."

BMA chairman Dr Mark Porter said: 'A fundamental problem with NHS 111 is that it employs non-clinically trained staff who follow a formulaic script rather than using clinical judgment to assess how calls are dealt with. Understandably this is likely to lead the call handlers, with limited experience of medicine, to be cautious and refer patients to the NHS when a trained professional could have encouraged them to effectively self-care.

"Key NHS services cannot afford to be taking on unnecessary work.'

Protecting other services

An NHS England spokesman said: 'What the statistics clearly show is that there is a massive demand from the public for the 111 service. To date it has coped impressively with this pressure, with the proportion of referrals to GPs and emergency services remaining steady despite the surge in demand. Given this popularity, however, we are continuing to look at ways to make the service even more robust including asking GPs to help support call centres and provide patients with the ability to get high quality medical advice as quickly as possible.'

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