NHS 111

111 is a free-to-call single non-emergency number medical helpline operating in England, Scotland and parts of Wales. The 111 phone service has replaced the various non-geographic 0845 rate numbers and is part of each country's National Health Service: in England the service is known as NHS 111;[1] in Scotland, NHS 24;[2] and in Wales, either NHS Direct Wales or 111 depending on area.[3]

This article focuses mainly on the NHS 111 service in England. For the equivalent service in Scotland using the same number, see NHS 24. For the service in Wales, see NHS Direct Wales.
The logo of NHS 111 in England

The transition from NHS Direct (0845 4647) to NHS 111 in England was completed during February 2014[4] with NHS 24 Scotland (08454 24 24 24) following during April 2014.[5] NHS Direct Wales started a phased roll-out of a similar 111 service in late 2016.[6]

As of June 2018, the 111 number was not in use across Northern Ireland.[7] The NHS 111 service was extended to Northern Ireland from February 2020, although this is for advice relating to the COVID-19 virus only.[8] NHS 119 is used for information relating to COVID-19. After dialling, callers will be asked to follow prompts to determine what nation they are calling from.

The service is available 24 hours a day, every day of the year and is intended for 'urgent but not life-threatening' health issues[9] and complements the long-established 999 emergency telephone number for more serious matters, although 111 operators in England are able to dispatch ambulances when appropriate using the NHS Pathways triage system.[10][11]

NHS Direct Wales continues to operate via 0845 4647, but began a transition to 111 during late 2016. Initially available in Swansea, Bridgend and Carmarthenshire, the service is due for a country-wide roll-out by 2021.[12]


Origins and development

During 2007, the Department of Health's Our NHS, Our Future report identified confusion surrounding access to certain NHS services in England and suggested the introduction of a national, three-digit number for out-of-hours healthcare services could help simplify the situation. Arrangements to identify and secure a suitable non-emergency number for England began in July 2009,[13] with the number 111 allocated by telecommunications regulator Ofcom in December of that year.[14]

In late August 2010, the Conservative-Liberal Democrat coalition government proposed that 111 would replace the existing NHS Direct (084546 47) telephone helpline in England.[15][16] This suggestion proved controversial as some critics feared that NHS 111 would be a "cut-price" replacement for NHS Direct, because NHS 111 would be staffed mainly by telephone advisors whereas NHS Direct had been staffed by nurses. Health Secretary Andrew Lansley said that the only major change would be the phone number, and that the service would be provided by existing staff.[15][17][18]

In July 2015 NHS England decided that what was required was an integrated urgent care access, treatment and clinical advice service which would operate over a large area. Clinical Commissioning Groups were told to stop any procurement exercises until revised commissioning standards and supporting procurement advice for integrated services were produced.[19] These service specifications for England were published in 2017.[20][21]

In June 2020 it was announced that there were plans to integrate LIVI software into the service in three regions of the UK. [22]

Management of the service

In England, the service is accountable at a Clinical Commissioning Group level but was originally commissioned on a regional basis, with a number of service providers. NHS Direct staff provided some of the 111 service during the original launch of the number, with other providers including regional ambulance trusts, and out-of-hours GP providers.

The lack of clarity as to accountability was criticised in a Deloitte report into the service launch failure by NHS Direct. As of December 2013 all NHS Direct contracts are being serviced by "stability partner" organisations such as ambulance trusts or GP co-operative organisations.

The service operates 24 hours a day. When GP surgeries are closed normally between 6.30pm and 8am, at weekends and at Bank Holidays the service will refer many patients to an out-of-hours service. This can also happen if practices are closed for training purposes.[23]

The service uses a clinical decision support system which structures the response to a call, which may range from telephone advice to the dispatch of an emergency ambulance. Calls are initially assessed by a call handler and may be passed to a clinician. The service has been criticised for being too cautious and directing too many patients to A&E departments.[24] GPs have complained that the service has not been inspected by the Care Quality Commission and that it may jeopardise the safety of out-of-hours services.[25]

Between 2010 and 2015 the service has handled 24 million calls with an average call length of 14 minutes. 97% of calls made have been answered within 60 seconds. Although 111 is a helpline for non-emergency cases, 10% of calls trigger the dispatch of an ambulance - 93,000 in the 12 months from April 2014 to April 2015.[26] A 2017 article in the British Medical Journal that studied the performance of the 111 service concluded that patients were "largely satisfied" with the service, while "its success against some key criteria has not been comprehensively proven."[27]

In January 2020 the Association of Ambulance Chief Executives called for a more joined up approach to the commissioning of 111, urgent care and ambulance services. The lead commissioner for 999 services is generally different, as those services operate over a wider area. The associations wants single regional specifications for integrated 999 and 111 provision, with no new tendering of 111 contracts which end this financial year. They want contracts for at least 5 year terms.[28]

Launch and initial service failures

The first NHS 111 trial, in County Durham and Darlington, started on 23 August 2010. Nottingham, Lincolnshire and Luton began trialling the service later that year.

NHS 111 was launched in a limited number of regions in March 2013 ahead of a planned national launch in April 2013. The British Medical Association wrote to the Secretary of State for Health to request that the launch be postponed.[29] Its chair, Dr Laurence Buckman, warned that the service as "a disaster in the making", and recommended delaying the full launch for safety reasons.[30][31] The public sector trade union UNISON also recommended delaying the full launch.[32]

The initial launch was widely reported to be a failure.[33][34] On its introduction, the service was unable to cope with demand; technical failures and inadequate staffing levels led to severe delays in response (up to 5 hours), resulting in high levels of use of alternative services such as ambulances and emergency departments.[30] The problems led to the launch being delayed in South West England, London and The Midlands[35][36][37] and the service was suspended one month after its launch in Worcestershire.[38]

The NHS 111 service was gradually launched in England over the course of 2013, with the rollout being completed in February 2014.[4] It was announced in October 2013 that NHS Direct would be closed down in 2014.[39] The 111 number was launched in Scotland in April 2014.[5]

Coverage

The 111 number for NHS services is currently available in all of England and Scotland. However, in Wales not all of the country is served by the number. The areas covered by the 111 number in Wales are: the Abertawe Bro Morgannwg University Health Board, Powys, Hywel Dda and Aneurin Bevan University Health Board (Newport, Caerphilly, Blaenau Gwent, Torfaen and Monmouthshire). If somebody needs to call 111 but it isn't available in their area, then NHS Direct Wales (0845 46 47) must be called instead.

As of early 2020, the NHS 111 service is available in Northern Ireland for advice relating to the COVID-19 outbreak.[8]

European number

Within EU member states and territories a similar type of service is available via the harmonised European number for medical advice 116 117 as one of a number of 'Harmonised Services of Social Value'.[40][41][42] Within the UK, however, the number 116 117 is currently not in use.

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References
  1. England, NHS. "NHS England » NHS 111". www.england.nhs.uk. Retrieved 2018-06-11.
  2. "NHS 24 - when to call 111". NHS 24.
  3. "111 Wales". Archived from the original on 2018-10-30. Retrieved 2018-06-11.
  4. "February will see the last NHS 111 sites go live | News | Healthcare Today UK". Healthcare Today. 2013-12-13. Archived from the original on 2018-06-12. Retrieved 2020-03-13.
  5. "Our new number is 111 - Health Information and Self Care Advice for Scotland". NHS 24. Archived from the original on 2017-07-05. Retrieved 2020-03-13.
  6. "New 111 Wales Service for Swansea, Neath, Bridgend & Carmarthenshire". NHS Direct Wales. 2017-05-02. Archived from the original on 2018-07-07. Retrieved 2020-03-13.
  7. Pym, Hugh (2015-12-16). "Northern Ireland's health challenges". BBC News. Retrieved 2018-06-11.
  8. "Coronavirus: NHS helpline extended to Northern Ireland". 2020-02-29. Archived from the original on 2020-03-01. Northern Ireland now has full access to the NHS 111 helpline service on coronavirus, the Department of Health has announced. [It] will replace the localised helpline [..] “people in Northern Ireland will have access to the same level of advice as citizens in England.”"
  9. "111 - The New Number for the Future of Non-Emergency Health Services : Department of Health - Media Centre". Department of Health. 2010-08-23. Archived from the original on 2010-08-31. Retrieved 2020-03-13.
  10. "NHS Direct delivering NHS 111 in East Midlands and East of England". NHS Direct. December 2010.
  11. "NHS Pathways". NHS Connecting for Health. Retrieved 2013-06-05.
  12. Clarke, Owain (2018-02-15). "Wales 111 phone line aims for full roll-out by 2021". BBC News. Retrieved 2020-03-13.
  13. "Ofcom | A Three-digit Number for Non-Emergency Healthcare Services". Stakeholders.ofcom.org.uk. 2009-08-20. Retrieved 2013-05-01.
  14. "Ofcom | New 111 non-emergency healthcare phone number confirmed". Media.ofcom.org.uk. 2009-12-18. Retrieved 2013-05-01.
  15. "NHS Direct launches". NHS Direct. 28 August 2010.
  16. "Government confirms plan to scrap NHS Direct helpline". BBC News. 29 August 2010.
  17. "UNISON Health Care - Our NHS Our Future". Unison.org.uk. Retrieved 2013-05-01.
  18. Bob Roberts (2010-09-10). "NHS Direct to continue after ConDem 'climbdown' - Mirror Online". Mirror.co.uk. Retrieved 2013-05-01.
  19. "All 111 and out of hours tenders suspended". Health Service Journal. 8 July 2015. Retrieved 8 July 2015.
  20. https://www.england.nhs.uk/wp-content/uploads/2014/06/Integrated-Urgent-Care-Service-Specification.pdf
  21. "Integrated Urgent Care Service Specification" (PDF). NHS England.
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  23. "Patients turned away after GP surgeries are all shut on the same day". Local Berkshire. 11 October 2014. Retrieved 11 October 2014.
  24. "Too many patients call the 111 NHS hotline and end up at A&E". The Sentinel. 15 September 2014. Retrieved 11 October 2014.
  25. "Concern over NHS 111 as CQC praises GP out-of-hours care". GP Online. 3 October 2014. Retrieved 11 October 2014.
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  27. "Has the NHS 111 urgent care telephone service been a success?". British Medical Journal. 2 June 2017. Retrieved 28 November 2017.
  28. "Ambulance chiefs call for commissioning shakeup". Health Service Journal. 8 January 2020. Retrieved 24 February 2020.
  29. "GPs urge delay to phoneline implementation". British Medical Association. 2012-02-25. Retrieved 2013-05-01.
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  31. "Contract changes and 'chaotic' reform put patients at risk, warns GPC". GPonline.com. 2013-03-22. Retrieved 2013-05-01.
  32. "Union says it warned NHS bosses about dangers of 111 service (From This Is Wiltshire)". Thisiswiltshire.co.uk. 2013-02-28. Retrieved 2013-05-01.
  33. "Patients failed by helpline disaster". This is Bath. 2013-03-01. Retrieved 2013-05-01.
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  37. "NHS 111 in 'total meltdown'". E-Health Insider. Archived from the original on 2016-01-31. Retrieved 2013-05-01.
  38. "Worcestershire withdraws NHS 111 advice line". BBC News. 2013-04-25. Retrieved 2020-03-13.
  39. "NHS Direct to close down next year". BBC News. 24 October 2013. Retrieved 10 November 2013.
  40. "Ofcom | Harmonised European numbers for harmonised services of social value (116XXX numbers)". Stakeholders.ofcom.org.uk. Archived from the original on 2014-07-28. Retrieved 2013-05-01.
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  42. Ray, Bill (2009-07-09). "NHS Direct gets to be number one, one, one". www.theregister.co.uk. Retrieved 2020-03-13.
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