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Roll out of new NHS 111 service delayed


The government has extended the deadline for the roll out of NHS 111 by up to six months following pressure from unions and clinical commissioning groups.

In a letter to CCGs, department of health national director for improvement and efficiency Jim Easton announced CCGs will be able to apply for an extension to the original April 2013 deadline if they do not think they will be ready by the original go live date.

The move follows lobbying from a range of interested parties including the British Medical Association, the Royal College of Nursing, the Ambulance Service Network, NHS Direct and some private sector organisations.

They are concerned that the roll out of the non-emergency phone number which will replace NHS Direct is being rushed through before the full evaluation of the pilot sites is complete.

In the letter Mr Easton said he and health secretary Andrew Lansley were still fully committed to delivery of the NHS 111 service but recognised an extension “may be necessary in some cases”.

He wrote: “That extension will be by application to an expert clinical panel, and should not delay roll-out in those areas that are ready to move ahead.

“It will however, help ensure that in those areas that need it, time can be taken fully to engage local clinicians and build delivery models for NHS 111 that have the support and endorsement of all local stakeholders.”

The clinical panel will publish the criteria that it will judge applications on shortly.

Contracts to provide the service have already been awarded in the North East, South East Coast, South West and much of South Central as well as some parts of the East of England. London is running a series of extended pilots and plans to go out to a full procurement after 2013.

NHS Direct chief executive Nick Chapman said the delay was likely to extend the life of the 0845 service but the full implications would not become clear until it was known how many areas had been granted an extension.

“NHS Direct believes that the Department of Health’s decision to allow further time to plan and implement these national changes to the urgent and emergency care service is the right one. It will allow for greater clinical engagement and ensure that the service is the best it can be for patients.

“The decision to allow an extension means that the period of transition from the 0845 46 47 service to the new NHS 111 service is likely to be spread over the next 15 months, rather than over the next nine months.”

However, Unison national officer for NHS Direct Michael Walker said concerns remained the government was pushing ahead with the roll out before the publication of the pilots evaluation.

He added: “It has been left to the vagaries of the clinical commissioning groups and that’s a problem; we need a centrally made decision [to slow the process down] as soon as possible.”

Royal College of Nursing chief executive and general secretary Peter Carter, said: “The RCN has deep reservations about the move to NHS 111 not least because people calling the service will only speak to someone clinically qualified around a third of the time.

“We call for this process to be totally paused while the final evaluation report on NHS 111 is published and considered. We ask the Department of Health to publish this report as soon as possible.”


Readers' comments (12)

  • I am a District nurse and we have been told that once 111 comes in patients will no longer phone us directly but they will phone 111 who will then phone the DN on a mobile to give the message. I cannot understand why this 'extra layer' is being added, currently patients phone our direct number and if we are not in leave a message, we check regularly while out and about and respond as soon as possible/ necessary. With the new system we are likely to be getting mobile calls while with dying patients or calculating drugs. If we leave the phone in the car - all that happens is that someone from the call centre will leave a message, we will have to phone them back [and maybe have to wait to get through before we can find out who it is that wants us.

    About 2-3 years ago we had a patient satisfaction survery and got fantastic results and ever since then there seems to have been a systematic effort to remove all that is good and responsive about our service.

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  • Heaven help us! this system stinks bitter.

    yet more gatekeeping. why should a patient have to speak to some stranger about their clinical problems and concerns? it is becoming more and more of an impersonal, inhuman, self service do it yourself society and do people not understand with very sick patients or those who are feeling very unwell or are elderly do not always have the strength and tolerance to go through this mechanical process. all they need is a familiar, confident and reassuring voice of somebody they know and trust. it is totally disgusting like many of the services in britain now are. employers and money first, patients/customers last.

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  • My friend is a district nurse (and I am an NHS Direct nurse), and she told me the other day that she had to go through the triage with the 111 call handler to get to speak to the OOH service about a patient. Absolutely ridiculous. Health professionals shouldn't have to go through that process and why should they have to justify their call to an unqualified call handler?

    By the way, the call she placed wasn't to one one of the 111 pilots that NHSD is doing, it was to Co Durham and Darlington, for which North East Ambulance Service now has the contract.

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  • "why should they have to justify their call to an unqualified call handler?"

    makes you see red and what about patient confidentiality and data protection? as I said above the whole system stinks and I wish no part of it for any patient or professional!

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  • This is about cheap service, no offence call handlers who do a great job. Humanity has been deprioritised in place of 'efficiency savings'.
    With all due respect this is what the country voted for in voting in the Tories.
    This needs the public to stand up and get angry both now and in the voting booths.

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  • I doubt the public will stand up though they always seem to gratefully accept whatever rubbish is thrown at them!

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  • The Problem?
    The Government.
    The solution?

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  • when will government learn that health service provision and the manufacturing industry is not the same thing at all and both need totally different styles of management to be effective or productive.

    Patients are not goods to be processed through a system and cannot be treated as such.

    Staff who chose to work in the caring professions do not have the same goals as those who chose to manufacture and selling goods as a career and should not be treated as such.

    Why don't we just go the whole hog and make more savings while we are at it by using call centres in India with operators whose English, on occasion, can be almost impossible to understand?

    My insurance company has a medical helpline in Australia. but they are highly trained nurses and pharmacists, listen carefully and sympathetically to your concerns and give sensible answers and reassurance in clear and comprehensible English and you can chat with them. They will do their best to find a suitable solution. Maybe if the NHS, persist with this system, they could learn lessons from them.

    On the other hand I have had negative experience of a large national medical call centre in Europe despite their claims to be the very best, latest, state of the art, flagship service. they boast about their high calibre of trained nurses and doctors but these do not listen to your concerns. they merely identify with the nearest part of the anatomy associated with the problem you describe and then fire about 20 questions from a list at you whether they are relevant or not. they then match your answers to a set of algorithms and tell you whether you need to consult a doctor or not and in what time delay, and in the meantime, or if not, what measures you should take which are a matter of common sense anyway or impractical. They do not offer alternative suggestions or any reassurance. You can take their suggestions or leave them, they do not give you the chance for discussion and seeking alternatives together which may suit your needs better.

    Some patients have chosen a cheaper model of healthcare to keep their premiums down where they have to go through this centre who authorise any doctor's visit. This may be cost effective but not quality care. If the centre decides a patient does not need a doctor and they go any way the insurance will not pay.

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  • Anonymous | 16-Jun-2012 9:48 am

    In reply to your 5th paragraph. This sounds very familiar and is not too dissimilar to a large NHS care delivery service in the U.K (NHSD).

    The NHS has persisted with this system for 12 years and has saved the government countless millions in diverting callers to self care (50%) instead of either an ambulance or A&E by foot or urgent care through OOH.

    In response to your 7th paragraph.

    This too sounds very familiar in that NHSD uses algorithms in order to clinically assess a patient together with critical thinking by a registered nurse. We are nurses, we are not by definition, Doctors. We cannot by profession, diagnose and consequently the algorithms used are implemented by doctors within a rigorously tested and effective computer system.

    However we can and do listen to concerns, and we do seek alternative care for callers as to what their particular circumstances are. Bearing in mind the constrictive service by telephone and on occasion the lack of information given to us, which is to be honest a trait of the human condition.

    However constrictive this is, we always endeavor to provide the most suitable outcome.

    Shame this service in it's entirety is coming to an end. At least in the U.K, who ever is providing the 111 service. There won't be an insurance says no answer.

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  • to the NHS Direct nurse above i am a NHS Direct (and 111 nurse), A health care professional calling to speak to another health care professional bypasses triage questions altogether. if this did not happen with your friend she should send feedback since this would appear to be a training issue.

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