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NHS telephone service ‘dilutes’ nurse role


The “significant dilution” of the role of trained nurses in the telephone service due to absorb NHS Direct has been laid bare in a parliamentary question.

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Health minister Simon Burns has revealed only 38 per cent of staff at a pilot site for NHS 111, the single access point for all non-emergency NHS healthcare services, are registered nurses.

This compares with 48 per cent at NHS Direct, which will be absorbed into NHS 111 by 2013.

Royal College of Nursing director of policy development and implementation Howard Catton said the details on the changes to skill mix were “concerning”.

He said: “It’s absolutely clear this is a significant dilution of skill mix. It’s about a 20 per cent reduction in the trained nursing workforce.

“NHS Direct is a unique service… but on a general medical or surgical ward, for a 20 per cent reduction in registered nursing to be safe, we would have to be seeing a reduction in patients and patient demand.”

Protocol based care was not wrong “in principle”, he said, but there was also a need to retain professional expertise.

For example, deciding whether a casualty should not be moved, or whether they needed to be moved to protect their airway.

Mr Catton also expressed concern about the training NHS 111 nurses receive.

While NHS Direct’s nurse advisers complete a month long classroom based training course, followed by a further four weeks of taking calls under clinical supervision, clinical training at NHS 111 amounts to a four day module, after a general two week course with non-clinical staff.

Around six weeks later, all staff then take part in a one day assessment.

The details were set out in answer to a written parliamentary question from Labour MP Ian Austin.

NHS 111 is being piloted in County Durham and Darlington. The pilot is due to be expanded to Nottingham, Lincolnshire, and Luton, before national rollout by 2013.

In August, health secretary Andrew Lansley appeared to suggest the new number would replace NHS Direct altogether, but later clarified the old phone number was merely being phased out.

A Department of Health spokeswoman this week confirmed that NHS 111 would “absorb” NHS Direct. An evaluation of the pilot has been commissioned, which will determine the final skill mix of the service.


Readers' comments (5)

  • This is worrying. The Government needs to be transparent as to whether this is a cost-saving exercise which accepts lower levels of patient safety, or a service improvement which will maintain or improve safety, if necessary at greater cost.

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  • Having previously worked at NHS Direct (after being qualified for almost 20yrs and spending the previous 4years on an acute medical admissions unit) I can say that I would not have liked to do 'phone triage without that experience behind me.
    Not sure how the new call centres will work but yes, anyone can read from a script and enter answers, but sound clinical judgements can only be made with experience.
    Calls may be able to be triaged themselves into ones where it is possible for untrained people to adequately deal with them and those which need qualified advice.If one of the ideas of the service is to ensure that clients approach the right services within the NHS, and I include pharmacies, then the Government need to ensure that the right people are available to give the right advice.
    Mantra should be right people, right place right time.

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  • I agree with the anonymous above me totally.

    ALL staff manning these phones should be QUALIFIED NURSES!!!! How the hell else can someone manage phone triage without training? Reading from a script is neither clinically safe nor morally right.

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  • Really the government needs, and has a duty, to be honest about what it's intentions actually are with this change. If that is the case then the public are aware and can make an informed decision about who they approach for care and advice concerning their health, which is after all the current, and appropriate, philosophy. Unlikely to happen in my opinion, as politicians are not renowned for their honesty, however that should not detract us from spelling out what the service is and what it isn't. Probably comes under the code in some way, wellbeing of patients or social justice or advocacy or something.

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  • As a Nurse advisor with NHSD, I have looked at 111 and there are very few roles for nurses. It is going to be health practitioners with little experience. The public want trained nurses to advise them not some one with limited knowledge. This is not a call centre dealing with mobile phones it is peoples lives we are dealing with!

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