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NHS 111 sending ‘increasing’ number of callers to emergency care

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The NHS 111 telephone service is sending an increasing number and also an increasing proportion of its callers to accident and emergency departments and ambulances, according to a think-tank.

The Nuffield Trust looked at data on NHS 111 from NHS England’s weekly winter operational updates, published each year from 1 December to the end of February, as well as monthly figures.

“What we found was a bit of a mixed picture”

John Appleby

Over the three years the service has been running, the number of callers who have been advised to go to A&E or been sent an ambulance has increased from around 150,000 a month to over 200,000.

But, crucially, the think-tank said the proportion of callers sent to A&E and ambulances has also been rising, from around 18-19% in the early period of the service to around 20-22% now, which translates into around an extra 20,000 people a month.

However, there is a high level of variation when looked at across the 42 separate 111 services operating in England. For example, 17% of all callers in the North East were transferred to an ambulance in 2016, but only 8% in South Essex.

Meanwhile, the percentage of people who were not recommended on to another service ranges from 8.45% in Hampshire and Portsmouth to 25% in inner North West London, said the trust in a briefing paper on winter pressures.

Likewise, the percentage of people who were not recommended on to another service ranges from 8.45% in Hampshire and Portsmouth to 25% in inner North West London.

“What’s not clear is why different areas are sending such varying numbers of callers to ambulances and A&E”

John Appleby

But the think-tank noted that overall the service appeared to be reducing, rather than increasing, pressure on emergency services – based on what people intended to do before they rang NHS 111.

Since it went live, around 45% of callers later surveyed said they would have gone to A&E or called an ambulance prior to calling, compared to the 20% that call handlers actually sent to these services.

Meanwhile, just over a third of users surveyed said they would have gone to primary and community services if NHS 111 had not existed, but call handers send around 60% of people to these services.

Therefore, the think-tank said the evidence appears to suggest that over the three years it has been in operation, NHS 111 has redirected large numbers from emergency care to general practice.

Professor John Appleby, Nuffield Trust chief economist and director of research, said: “We wanted to see whether there was any truth in the assertion that referrals from NHS 111 may be contributing to the pressure on A&E departments and ambulance trusts.

“What we found was a bit of a mixed picture,” he said. “It’s a concern for the NHS that the proportion of callers sent to A&E and ambulances is growing all the time.

John Appleby, King's Fund chief economist

John Appleby, King’s Fund chief economist

John Appleby

“But surveys of callers appear to show that even higher numbers would have opted for these emergency services if they hadn’t been able to ring 111,” he noted.

He added: “What’s not clear is why different areas are sending such varying numbers of callers to ambulances and A&E, and it would be worth NHS England or the Department of Health investigating.”

The NHS 111 telephone service controversially replaced NHS Direct in 2013. Most callers are dealt with by staff with no clinical background, but around a fifth are referred to nurses or paramedics.

The service has a range of options open to it, from despatching an ambulance or advising callers to go to A&E, to sending a GP or district nurse or advising people to see a pharmacist.

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