Nick Summerton: Diagnosis of failure as helpline adds to pressure on A&E

As the gas poured out and filled the house, my wife phoned the emergency gas number.

The response was incredible – 
a few simple questions to ascertain the problem and the location, some useful advice on safety and the rapid dispatch of a gas crew.

By the time I arrived home the only evidence of the crisis was an enormous hole in our front lawn.

Sadly, the NHS 111 telephone service established last year by the Department of Health isn’t proving nearly as effective.

It now manages all requests for urgent help, including those for GP out-of-hours care and cases that may need an ambulance.

The service is staffed by non-clinicians who use a computerised assessment system, NHS Pathways, to triage calls to other services or care at home.

In setting up the phone line, politicians and healthcare managers had clearly drawn heavily on the experience from other urgent and emergency services.

What they failed to appreciate, however, is that patients are a little more complicated to assess than a burst gas main.

Many of us warned about the folly of the 111 service. As a GP with over 30 years’ experience I can find it challenging to assess some patients over the phone.

Expecting lay people to do this, supported by a rather simplistic computer programme, was just plain stupid.

In addition to working as a GP I also have longstanding research and teaching interests in diagnostics and, when the proposal to establish the 111 service was first mooted, I sent over a dozen free copies of my latest book, Primary Care Diagnostics, to some local NHS managers and colleagues at the Department of Health.

I also offered them a copy of our own GP-led patient triage protocol.

Sadly I did not even receive any acknowledgement and have no idea if they bothered to read them.

So, nearly one year on from the launch of the service what is the situation?

As predicted, more ambulances are being arranged to ferry callers to hospital, leading to even greater pressure on accident and emergency departments at a time when a shortage of staff means spending on locum doctors to plug the gaps in A&E units has risen by 60 per cent in three years.

Researchers from the University of Sheffield found that, with the advent of the NHS 111 service, there was a three per cent increase in ambulance dispatches.

Over the Christmas period a newspaper investigation also highlighted concerns about young and inexperienced call centre 
staff struggling to cope with a deluge of calls.

Even more worrying is the fact that there have been reports of some serious conditions – such as meningitis – being missed.

In just the first six weeks of the service’s launch 22 serious incidents were reported. Moreover, in a survey of 440 
GPs across the country, three-quarters indicated that they thought the triage systems at the NHS 111 call centres were unsafe.

On my part, as a GP, I am in receipt of the reports from the services but, as these are computer generated, they are crammed with redundant and useless information. For example, just before Christmas I was faxed a three-page report which looked concerning. But reading on to the third page it was clear that he was suffering from simple back pain.

Another report indicated that the computerised triage assessment couldn’t be completed as the patient wasn’t breathing.

Despite all the concerns about NHS 111, I am confident that the politicians will try to keep it alive and, moreover, seek to pass the blame to GPs for the crisis in accident and emergency departments.

On my part, I would also like to see some elements of the service retained but relocated to the Thackray Medical Museum in Leeds for the interest, education and amusement of future generations.

Shutting down the phone line would release a considerable sum of money that could then be allocated back to practices to allow GPs to offer extended opening hours (including weekends).

But, until our politicians come to their senses, what should we do about getting good quality advice when GP surgeries are closed?

Interestingly, the last year has also seen another important development in out-of-hours medical advice.

The major health insurers have all established 24-hour advice lines for their customers staffed by nurses and/or general practitioners.

One particularly good value package, with no upper age limit, is being offered by the York-based friendly society Benenden Health.

Looks like I have next year’s Christmas and birthday presents for my parents sorted.

• Dr Nick Summerton is a GP in East Yorkshire.