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NHS 111: lessons to learn

Elliot Bidgood, 30 April 2013

A developing story in health in recent weeks has been the issues with the government’s rollout of NHS 111, a new non-emergency triage telephone service designed to combine NHS Direct and local out-of-hours services, since its initial ‘soft-launch’ in the run up to April 1st. The idea is that by combining these services and equipping operators with the ability to direct patients to a variety of different services, up to and including sending out ambulances, the NHS can more effectively manage patient needs and demands on the service.  The government expects 37% of the population to use NHS 111 each year.


However, the rollout has been problematic, with entire areas not yet functional weeks after the passing of the April 1st deadline, delays being reported due to understaffing and wrong courses of action being suggested in some instances. NHS Worcestershire has withdrawn its service and Pulse magazine has today reported that 16 NHS 111 providers they investigated (out of 44) have had to draft in extra staff, including from 999 operators in some instances (although local spokespeople have stressed that these operators are only working for NHS 111 in an overtime capacity).

Therefore, despite NHS England’s aim for the rollout to be complete by June, local CCGs and medical professionals are said to be sceptical – 70% of doctors have little confidence in the scheme, according to It should of course be said that large-scale technological and service rollouts in health systems inevitably suffer some teething problems of one kind or another, but the government would be well-served to listen to the advice of medical professionals about what needs to be done to sort out NHS 111.

One of the main concerns has been that the service has relied too heavily on lay staff with only six weeks training who read through symptom checklists, with referrals then made to trained staff only if this is deemed necessary. The BMA has rightfully warned about the risks of this approach. 75% of NHS Direct staff were nurses, while only 17% of NHS 111 staff are, according to Unison. Among doctors that did still express some faith that the reforms could be rectified and made to work, this criticism was a key theme. The government will need to take steps to slow the implementation process and ensure that qualified staff take the calls and direct patients adequately, if the intended benefits for patients and the health service are to materialise.

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