The NHS Alliance surveyed members of its clinical commissioning federation, which covers most clinical commissioning groups (CCGs) across England, about NHS 111. The services is a hotline for patients with urgent, non-life threatening health problems set up as an alternative to calling 999.
Despite CCGs being key to the implementation of NHS 111 when it is rolled out nationally in 2013, the survey found that commissioners felt disengaged from its establishment and concerned that it would make no improvement to patient care.
Over two thirds (68%) of the 51 CCG leads who responded to the survey disagreed with the statement: 'NHS 111 will ensure that patients get to the right service for their needs more quickly.'
Just 23% were ‘quite confident’ that the introduction of NHS 111 in their area in 2013 would be a success.
Results also revealed that despite CCGs being told they could choose whether to pilot or procure NHS 111, or set up a service using existing providers, in reality very few had such a choice.
Nearly 80% of commissioners whose CCG had procured the service said they had done so because the decision was made by their SHA or PCT cluster.
When asked to define their level of clinical engagement with the establishment of NHS 111, just 11% said they experienced ‘good engagement’.
Over a third agreed with the statement ‘no real engagement – the decision was out of my hands’ and 23% said ‘I knew what was happening but had no say’.
When asked is they would commission NHS 111 if they had the choice, only 4% answered 'Yes'.
One respondent commented: ‘We should look at the experience of the pilots - it replaces NHS Direct at best and fuels demand for urgent care and acute admissions. We need to be able to change the national specification.’
NHS Alliance urgent care lead Rick Stern said: ‘We remain supportive of the idea and want to work in partnership with the DH and other national partners to ensure that local commissioners are actively involved in the development of NHS 111.
‘However our members currently feel disengaged and believe there is little room for local flexibility. We need to take steps to address this now, as otherwise both the 111 programme and the credibility of local clinical commissioning will suffer.
'While there is support for NHS 111 in principle, there are substantial concerns about the speed and style of implementation.’
Responding NHS Alliance's findings, medical director of NHS Direct Brian Gaffney said it was important for GPs concerns to be taken seriously, because CCGs would inherit NHS 111 contracts and be responsible for the service in their local area.
He said: 'We know from our pilots that NHS 111 supports fewer patients to self-care than the 0845 4647 service, and refers more patients to face-to-face urgent care services. There is a danger of NHS 111 leading to substantial additional costs across the health system if it is not commissioned as part of the local urgent care services. The expertise for taking this forward lies with local clinicians and they need to be fully involved immediately.'
