111 service

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Based on the layout of the dial of the traditional dial telephone, emergency services in many countries are obtained by dialing either 111 or 999, which tend to be free phone numbers. In the UK the early phone systems generated 111 internally, so the signal was not available for other uses initially.

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In the UK you dial 999 for emergency services (112 also works). But an overseas visitor to the UK might well dial 111 in an emergency. If its a health related emergency as from October 2013 they will be relatively OK as they will get through (in due course) to an urgent NHS service. The official web site says "Call 111 if:

  • you need medical help fast but it's not a 999 emergency
  • you think you need to go to A&E or need another NHS urgent care service
  • you don't know who to call or you don't have a GP to call
  • you need health information or reassurance about what to do next"

When the system was rolled out early in 2013 some providers had insufficient operator capacity and others have discovered that their contracts are not viable as modelling of demand was inaccurate[1]. This included some providers of the former NHS Direct service (which was not free), The roll out is reported to have caused inappropriate demand on A&E services with headlines such as "A&E at crisis point: Untrained NHS 111 staff send ambulances to 250,000 more emergencies"[2] and increased GP workload with poor reporting systems on patient contacts. These issues were thought likely to occur by many health professionals given the experience with NHS Direct a decade before

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The initial implementation and systems integration was badly commissioned.

  • 1997 Labour Government's NHS White Paper, The New NHS, the main aim of NHS Direct was: ‘to provide people at home with easier and faster advice and information about health, illness, and the NHS, so that they are better able to care for themselves and their families’. Initially to have a national nurse-led telephone helpline.
  • 1998 March 1998. Pilots run by Ambulance Trusts in Lancashire, Northumbria, and Milton Keynes started taking phone calls from the public
  • 1998 December 1998. Favourable interim report by University of Sheffield[3]
  • 1999 April 1999. Over 40% of the country covered by the NHS Direct telephone service.
  • 1999 December 1999. NHS Direct website
  • 2000 October 2000. Nation wide (England and Wales) NHS Direct telephone service.
  • 2001 July 2001 Favourable final report by University of Sheffield[4]. It did however note "related services show a general support for the principle of NHS Direct, although there are a range of concerns about the practical implementation". Other reports from the same research unit noted "The advice given by NHS Direct nurses may be influenced by the length of their experience...this...has little impact ...compared with the influence of the software and the variation between individual nurses... The challenge facing NHS Direct is to ensure the appropriateness of the software recommendations"[5].
  • 2002 NHS 24 rolled out in Scotland.
  • 2003 "...at least one in eight callers may receive advice leading to an unnecessary contact with health services."[6]
  • 2010 July 2010 Coalition government’s white paper Equity and Excellence: Liberating the NHS plans to develop "a coherent 24/7 urgent care service in every area of England"
  • 2011 October 2011. NHS 111 phone line plan announced for all non-emergency NHS care and advice by April 2013
  • 2012 February 2012. Calls by Doctor's organisations and Ambulance services to delay full rollout so as to evaluate pilots after a few issues reported
  • 2013 April 2013 Ministers press ahead with national rollout of 111. Launch problems include poor call response times, staff shortages, treatment delays, and ambulances being summoned unnecessarily
  • 2013 July 2013—NHS Direct withdraws from all its contracts to run NHS 111 services in England, claiming that the contracts were not financially sustainable
  • 2013 November 2013 NHS England proposes enhancing 111 so patients can talk directly to a doctor, nurse, or health professional or book an appointment with their GP if needed. Commissioning adjustments will cost tens of millions of pounds[7].

References