The survey of 88 doctors in the north east of England, is thought to be first test of GP opinion since the new phone service was rolled out nationally in March.
Just 7% of GPs reported a good or very good experience, and 83.3% of those who worked in out-of-hours care said the service had got worse or much worse since the introduction of NHS 111.
Asked about the quality of clinical information supplied by the service, just 4.6% of GPs surveyed said it was clear and concise, against 88.5% who said it was not.
Dr Ken Megson, secretary of Gateshead and South Tyneside LMC, which helped to carry out the survey, told GP information passed to GPs by NHS 111 providers was often indecipherable making it difficult to identify or understand the patient’s problem. ‘If you can't properly prioritise on clinical grounds, then patient safety problems arise,' he said.
The triage service, incorporating GP out-of-hours phone services, was piloted in parts of the north east of England in August 2010.
Dr Megson said GPs in the area had been warning about problems with the service for the past six months.
The results come days after NHS England launched an external investigation into faillings in the service and warned that providers could face fines and contract cancelations if they did not improve.
Deputy chief executive Dame Barbara Hakin said that following unacceptable levels of service in some areas, there had been ‘very significant improvements’ overall in recent weeks, with 90% of calls last weekend achieving ‘gold standard'.
But she warned a ‘couple of providers’ had been responsible for ‘seriously poor performance’.
‘NHS England will not shy away from working with CCGs to support them to invoke the serious financial penalties, or indeed to revoke the contracts where we believe providers cannot show that they are going to be able to improve.’
Dame Barbara said an external urgent review of the service would consider the actions of ‘predecessor organisations’, including how contracts ‘were awarded to providers who so patently, on day one when the service went live, could not provide the service that had been commissioned’.
In general, what was your experience of NHS 111?
GPs' comments from the survey:
- 'Triage by non-clinical/inexperienced staff, constrained by rigid protocol with no discretion to close an encounter'.
- 'Waiting times for ambulances are much longer than they used to be. I have seen examples of poor judgement by 111 sending ambulances as emergency when not needed.'
- 'Outcome of triage can be inappropriate and misleading at times.'
- 'I am worried about some of the clinical decisions made by 111. I had the experience of one of my patients who had been unwell and advised quite inappropriately to wait till the next day to see me. I also worked a session in an urgent care center where an elderly gentleman who was clearly unwell and should have been sent straight to hospital following triage by 111 was brought in to the Urgent Care Center by transport arranged by 111 and collapsed during assessment.'
- 'Unfortunately the operators who answer the call often are lay persons and the triaging outcome can be quite worrying regarding patient safety.'
- 'Patients given GP out of hours appointments unnecessarily.'
- 'Increased unnecessary workload.'
- 'Communication is nothing short of terrible-just a list of negative responses to a computer protocol-making it impossible to discern any clinical information.'
- 'Everything is tagged "urgent". The information provided is wholly unhelpful.'
- 'Inappropriate assessment, undue patient distress, unmanageable strain on services, real emergencies missing out, failure of NHS management to heed warnings and take apprpriate action.'
- 'The faxed forms regarding patient contacts are largely incomprehensible.They seem more concerned about avoididing litigation than giving information about the problem and action taken.'
- 'Increased workload for out of hours. Waste of GP's time as minor medical problems such as cold/flu symptoms are triaged for GP advice.'
- 'OOH in past was fully managed by clinicians triaging, and was much better managed even under severe pressure, now as inappropriate urgency given to calls and inappropriate home visits requested this is causing enormous pressure on services.'
- 'The patients are exasperated by the whole process.'