Quarter of NHS 111 calls end up at A&E

The latest NHS England figures show that the West Midlands call centre sent 23,089 people to A&E in March 2019, 25 per cent of all callers.

This is up from 18 per cent in March 2014, when 11,802 patients were referred to A&E. That was in the first year of full service for NHS 111.

NHS 111 is a 24-hour helpline for patients who need medical help but do not need to call 999, which took the place of NHS Direct and some GP out-of-hours services in 2014.

The West Midlands helpline handled 91,372 calls in March 2019.

It referred 58 per cent of these to primary care, such as GP surgeries, pharmacies and dentists. About two per cent of them were advised to rest at home.

The service is commissioned by local clinical commissioning groups, which make spending decisions for health services, and the helplines are run by ambulance trusts, GP surgeries and private healthcare companies.

Nationally, there is significant variation in the number of A&E referrals by each service.

Gloucestershire NHS 111 sent 27 per cent of all callers to A&E in March 2019, while Hertfordshire sent just 13 per cent.

Most calls are dealt with by staff with no clinical background working to a set script, although around a fifth of callers are referred to nurses or paramedics.

Adam Steventon, Director of Data Analytics at the Health Foundation, said: "There is broad recognition that a large number of people calling NHS 111 are being directed to A&E, and NHS England have stepped up the amount of clinical input available to those seeking help through this route to try and tackle this.

"In looking at the impact of making more clinicians available in NHS 111 call centres, we found that children and young people who were reviewed by a GP were less likely to go on to A&E than other patients.

"However, the lower levels of attendances were focussed on minor treatment units, with little evidence that review by a GP reduced attendances at major A&E departments, which is where most of the pressure is."

The Nuffield Trust, an independent health think tank, conducted an analysis of the service in 2017 and warned then of the increasing proportion of people being sent to A&E.

John Appleby, chief economist and director of research for the Nuffield Trust, added: "It’s a concern for the NHS that the proportion of callers sent to A&E and ambulances is growing all the time.

"However, 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."

Its report said that health professionals have been strongly critical of the decision to scrap the NHS Direct Service and replace it with NHS 111.