Has the NHS 111 urgent care telephone service been a success? Case study and secondary data analysis in England

Abstract

ObjectivesTo explore the success of the introduction of the National Health Service (NHS) 111 urgent care service and describe service activity in the period 2014–2016.DesignComparative mixed method case study of five NHS 111 service providers and analysis of national level routine data on activity and service use.Settings and dataOur primary research involved five NHS 111 sites in England. We conducted 356 hours of non-participant observation in NHS 111 call centres and the urgent care centres and, linked to these observations, held 6 focus group interviews with 47 call advisors, clinical and managerial staff. This primary research is augmented by a secondary analysis of routine data about the 44 NHS 111 sites in England contained in the NHS 111 Minimum Data Set made available by NHS England.ResultsOpinions vary depending on the criteria used to judge the success of NHS 111. The service has been rolled out across 44 sites. The 111 phone number is operational and the service has replaced its predecessor NHS Direct. This new service has led to changes in who does the work of managing urgent care demand, achieving significant labour substitution. Judged against internal performance criteria, the service appears not to meet some targets such as call answering times, but it has seen a steady increase in use over time. Patients appear largely satisfied with NHS 111, but the view from some stakeholders is more mixed. The impact of NHS 111 on other health services is difficult to assess and cost-effectiveness has not been established.ConclusionThe new urgent care service NHS 111 has been brought into use but its success against some key criteria has not been comprehensively proven.

Impact of Emergency Medicine Consultants and Clinical Advisors on a NHS 111 Clinical Assessment Service

“…The number of calls where the recommendation was to attend ED was determined. This formed 8% of the total calls triaged (NHS 111, MDS) 6. From this group, calls with recommendation to attend ED either in 1 or 4 hours were extracted.…”

Impact of using data from electronic protocols in nursing performance management: A qualitative interview study

“…For instance, the National Health Service (NHS), the national, free‐at‐the‐point‐of‐entry healthcare system, provides access to advice from healthcare professionals via its 111 telephone call service. Time‐stamped electronic data collected during these calls are used to compare nurse response times and numbers of enquiries resolved within the time required by their protocol (Pope et al, ; Prichard, Turnbull, Halford, & Pope, ; Ruston, ). Previous research has shown that nurses can resist electronically based protocol implementation in overt and covert ways (Pope et al, ; Prichard et al, ; Ruston, ; Timmons, ), thereby undermining the aims of the protocol (Timmermans & Berg, ).…”

“…Time‐stamped electronic data collected during these calls are used to compare nurse response times and numbers of enquiries resolved within the time required by their protocol (Pope et al, ; Prichard, Turnbull, Halford, & Pope, ; Ruston, ). Previous research has shown that nurses can resist electronically based protocol implementation in overt and covert ways (Pope et al, ; Prichard et al, ; Ruston, ; Timmons, ), thereby undermining the aims of the protocol (Timmermans & Berg, ). The research to date has focused on NHS 111 (Pope et al, ; Prichard et al, ; Ruston, ) electronic patient records (e.g.…”

“…Previous research has shown that nurses can resist electronically based protocol implementation in overt and covert ways (Pope et al, ; Prichard et al, ; Ruston, ; Timmons, ), thereby undermining the aims of the protocol (Timmermans & Berg, ). The research to date has focused on NHS 111 (Pope et al, ; Prichard et al, ; Ruston, ) electronic patient records (e.g. Timmons, ), or interactive whiteboards (Allen, ), which are not time critical.…”

Where is the evidence for automated triage apps?

“…Retrospective evaluations,2 before and after studies,3 and case study analyses4 are no substitute for randomised controlled trials.…”