NHS 111. Again. Is it THE problem? And how much is it costing?

Two things to me seem obvious. No doctor likes NHS 111. Secondly if you open another gate to the NHS, more people will go through it! It’s worth remembering that NHS 111 replaced NHS Direct which had one medically trained person to every two call handlers. According to the Royal College of Nursing, NHS 111 has 15 call handlers to one nurse. Inevitably someone working from a script with no medical knowledge is not going to be able to draw on experience or intuition when assessing and signposting callers, and this process will inevitably result in more false positives i.e. thinking there is something wrong with someone when there isn’t.

There are already known core reasons to the problem of more people going to A&E when it’s not an accident or an emergency

  • They go because there is a 9 out of 10 chance they will be seen and sorted within four hours
  • They go, because as an immigrant they come from countries which don’t have good GP services and going to hospital is where they are used to going (One London hospital recently found that 20% of it’s A&E attendees had no registration with a GP)
  • They go because they can’t get a GP appointment for 2 weeks
  • They go because they are elderly and worried and have not had the reassurance or management or care that they needed
  • They go because they have drunk too much and have become ill or had an accident

NHS England have responded to the criticism of NHS 111 by saying: “Doctors and nurses in A&E work incredibly hard to provide patients with the urgent care and treatment they need and have managed significant pressures as demand for urgent care grows.” We totally agree.

They also said: “However, what emergency doctors such as Dr Mann do not see is the even greater number of patients who are treated effectively and efficiently using the 111 helpline. Last year 111 received over 12 million calls and as a result offered treatment to over two million people who would otherwise have visited A&E,” (Do they know this? Were people actually asked whether they would have gone to A&E, or visited their pharmacist, dentist, GP, optician, practice nurse etc?)  “and another 580,000 who would have called 999 for an ambulance, reducing a significant amount of unnecessary pressure on our urgent care services.” Again, were they asked if this is what they would have done, or is it extrapolated from the figures? And if they would have, yet they didn’t need A&E, or 999, why did they call NHS111 and not their GP?

The one question no one seems to be asking, is why are we keeping the public dependent on professionals instead of promoting self-care through technology? If I can see my GP record online (promised to all of us from April 2015), if I can have digital health technology (from free apps to a telehealth system to self-monitoring devices), if I can call a doctor via DrThom (£15 a call) or Babylon Health (£8 a month) or DoctorToday (£45) then why isn’t the NHS helping the public to help themselves?

I wonder how much NHS111 is costing us….does anyone know?


About Julia Manning

Julia Manning is a social pioneer, writer, campaigner and commentator. Formerly a clinical optometrist specialising in diabetes and visual impairment, she is the founder and Director of 2020health, an independent, social enterprise Think Tank whose aim is to Make Health Personal and Social. 2020health has through research, events and campaigning influenced opinion and action in fields as diverse as bioethics, alcohol, emerging technologies, fraud, education, consumer technology and vaccination. In 2014, 2020health were founding partners of the Health Tech and You Awards with Axa PPP and the Design Museum. Since 2016, 2020health has increasingly focused on digital health and public health in the community. Julia is a Fellow of the RSA and now also a part-time PhD student at the UCL Interaction Centre, studying the use of digital technology for stress management in the workplace. Julia has shared 2020health's research widely in the media (BBC News, ITV, Channel 5 News, BBC 1′s The Big Questions & Victoria Derbyshire, BBC Radio 4 Today, PM and Woman's Hour, LBC) and has taken part in debates and contributed to BBC’s Newsnight, Panorama, You and Yours and ITV’s The Week.
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