GP leaders back plans to replace NHS Direct

Plans to adopt the NHS 111 hotline across England to replace NHS Direct have been welcomed by GPs. Susie Sell reports.

NHS Direct has been criticised for increasing GP and A&E workload but GPs hope NHS 111 will be better (Photograph: UNP)

GP leaders have backed plans to replace the NHS Direct hotline with an NHS 111 number.

The profession has had a mostly fraught relationship with NHS Direct, levelling criticism at its cost and its impact on GP and A&E workload.

But GP leaders appear more enthusiastic about the new NHS 111 service, with Dr Fay Wilson, chairman of the BADGER out-of-hours co-operative in Birmingham, saying she thought it would have more of a 'signposting' function, rather than offering clinical advice.

Appropriate direction
GPC chairman Dr Laurence Buckman said stripping out the advice function would mean callers were directed to the most appropriate service more quickly.

He said it was better for NHS services, including practices, to deal with a patient's problem from the outset than 'having to cope with the fallout of patients from NHS Direct'.

'If it increases workload for GPs, it will only be by a modest amount,' Dr Buckman added.

Dr Wilson agreed the new service was unlikely to mean a barrage of patients turning up at, or calling, surgeries and out-of-hours providers.

'We already get loads and loads of calls coming from NHS Direct,' she said. 'We are not expecting things to get worse.'

Nevertheless, and despite extensive reporting of its demise, a spokeswoman for NHS Direct stressed that the new 111 hotline would replace only its telephone service. NHS Direct would continue to exist, she said, although she conceded its scope might be affected by the ongoing government review of NHS IT.

She also defended the record of the existing service.

'NHS Direct has been criticised in the past by GPs for "signposting" too many patients to their surgeries,' she said.

'Results from recent work with external clinicians shows that, in most cases, GPs and other clinicians agree with the level of care NHS Direct provides.

'In 2009/10, 1.9 million GP consultations were avoided through patients' use of NHS Direct's services.'

But Dr Wilson said she believed the algorithm NHS 111 call handlers will use to decide where to direct patients would broaden the range of services people were directed to.

'Rather than going to GPs, callers will also be told to consult pharmacists and other services,' she said.

Dr Wilson also said she thought standards of staffing at the new 111 service would still be high to ensure 'life threatening emergencies will also be identified'.

Lay staff
NHS 111 call centres will be staffed by 'call advisers' rather than NHS Direct-style nursing teams. But shifts will have a 'clinical supervisor'.

Dr Nigel Watson, chief executive of Wessex LMCs, said use of lay staff by NHS 111 would have to be 'evaluated properly'.

But Dr Wilson said training for NHS 111 call advisers - around 60 hours plus further tuition on assessing callers' symptoms and identifying the right service for them - was on a par with training for NHS Direct health advisers.

NHS 111 is currently being piloted in Durham and Darlington, and three further pilots are planned, in Nottingham City, Lincolnshire and Luton.

Dr Watson said it was inevitable that the handover to NHS 111 would throw up some teething problems.

But he added: 'Hopefully the fact that it will be piloted first means lessons will be learned and integrated into whatever comes in the future.'

Editorial: Goodbye to NHS Direct and good riddance

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