Exclusive: GPs lose out on contracts for NHS 111

NHS 111 will drive up GP workload and cut patient care, an unpublished report has revealed, as GPs face being excluded from providing the services themselves. See NHS 111 providers map below.

A report on NHS 111 pilot sites by researchers at Sheffield University has concluded that the service would increase GP visits, A&E attendance and ambulance call-outs, GPs have said.

The warning comes as a GP investigation finds that PCTs are handing most NHS 111 contracts to non-GP providers, with ambulance trusts the most common providers of choice.

GP leaders have repeatedly raised concerns about the non-urgent care number and the GPC has called for its roll-out to be delayed until the pilots' findings have been evaluated.

Increase in GP workload
Shropshire LMC chairwoman Dr Mary McCarthy said the Sheffield report revealed that NHS 111 resulted in more GP appointments, as well as A&E visits and ambulance call-outs. 'We don't know exactly what is going to happen but data from the pilots does suggest that it increases GP workload.'

NHS 111 providers map

View NHS 111 providers in a larger map
Key   Key  

NHS Direct
Not for profit

Private provider

Community benefit society

Ambulance service
Foundation trust

At the UK conference of LMCs last month, GPC negotiator Dr Peter Holden revealed he had also seen the report. He could not discuss its findings, but said a motion warning non-clinician-led triage would cut care and raise GP work was 'prescient clairvoyance'.

Speaking to GP, he said: 'You can't just put some call handler on this. Where there are good GP-led social enterprises running out-of-hours already, we believe they are the people who should handle NHS 111.' He added that non-clinical call handlers would drive up GP referrals, because they would be overly cautious and 'triage safe'.

Even though the pilot study findings will not be available until later this year, 19 PCTs have already chosen a preferred NHS 111 provider, GP has found (see map above).

Just three PCTs plan to use not-for-profit GP-led organisations to provide NHS 111 services, while nine intend to use ambulance service providers.

Dr McCarthy said awarding NHS 111 contracts to non-GP providers would render GP out-of-hours services 'unviable' because funding for call handling would go to the NHS 111 provider.

A DH spokesman denied ambulance trusts would over-refer and said services would have 'a high level of local knowledge and well-trained staff'.

Responding to the concerns, Berenice Groves, NHS 111 North East programme director, said:  ‘We need to be clear that NHS 111 is not trying to provide GP out-of-hours services. It is a telephone assessment service for patients to call when they need medical help quickly, but don’t know where to go.

‘By providing a call handling facility for NHS 111 via the North East Ambulance Service in partnership with Northern Doctors Urgent Care Ltd, we are ensuring that there is a consistent approach to telephone assessments in County Durham and Darlington.’

A spokesperson from Leicester, Leicestershire and Rutland PCT Cluster said: ‘Here in Leicester, Leicestershire and Rutland a team of local health professionals (including GPs, consultants and nurses) and patient representatives are helping to shape the local NHS 111 service. We are committed to developing the best possible service for local people and GPs embracing local innovations as well as learning from best practice elsewhere.’

Dr Nick Morton, GP and associate director of clinical services for the East of England Ambulance Service NHS Trust (EEAST), said: ‘EEAST holds the 111 contract in Norfolk and has also been the GP out-of-hours provider in the county since 2004. This clearly, as the concerns of GPs state, puts EEAST in an unparalleled position with regards to local expertise and ensuring the best interests of the out-of-hours service and therefore GP surgeries and patients. This integrated approach will be of huge benefit to emergency and urgent services and of course patients.’

Mike Barradell-Smith, marketing director at independent provider Harmoni, said: ‘We agree that a GP-based organisation such as Harmoni is well placed to deliver the new 111 service and this is further supported by our success in winning contracts against non GP-based organisations. We also believe that whether the 111 provider is an NHS body or not has little relevance to patients as what they want is high quality care available when they need it, something the current tender processes are designed to achieve.’

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