NHS England’s national medical advisor on 111 Dr Ossie Rawstorne said it had been ‘naive’ to assume putting GPs into the phone triage service would solve its problems, and the existing workforce should have been better equipped instead.
GP early intervention pilots were launched earlier this year in an attempt to provide clinical advice earlier for those who require it and reduce the number of urgent and acute referrals from the service.
Dr Rawstorne was speaking at the conference of out-of-hours group Urgent Health UK about new commissioning standards for the 111 services, which are set to be reprocured by CCGs. He said the focus should have been on making better use of the existing clinical and non-clinical workforce, warning that he was ‘not sure we've equipped it adequately to do the job we're asking’.
GP pilot findings
The findings of a study into the GP pilots could be published within weeks. But Dr Rawstorne, a former GP, said there were no ‘prizes for guessing what the findings are’.
‘Yes you can increase the number of self care patients, you can reduce the acuity of ambulance dispositions and ED dispositions, but it's actually very difficult to recruit GPs to do it and it's quite an expensive way to do it,' he said.
Introducing a new set of professionals who are ‘quite rare beasts’ into the system was ‘a bit odd’, said Dr Rawstorne, ‘when we weren't really doing anything about understanding our current workforce’. A new programme of workforce development will now address that issue.
Call handling ineffective
The NHS Pathways algorithm used by 111 call handlers is not effective for a big proportion of patients - those with complex needs, said Dr Rawstorne.
‘The difficulty is finding exactly how big that group is, and finding where they sit, and how you identify them right at the beginning of the call, so you don't put people through two processes.’
What needs to happen, he said, was to make the service’s existing clinical workforce ‘a lot more effective than they are’.
‘We've already got a big workforce. It doesn't appear to be delivering the improved outcomes I would expect from their involvement in individual cases, so what do we need to do differently if we are going to improve those?’
He added that developing the workforce should have happened before the GP pilots.
‘I wish we'd done that bit first, and not the GP bit. But at the time, it seemed like the whole world was saying the answer to 111's problems is just put GPs in there and people bought into that notion a little bit. And I think it was always a little bit naive to think that even if we wanted to, we could, and whether it was the right place for them to sit, anyway. So I think we've lost a bit of time, but we can't afford not to do it. We have to solve that problem.’
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