The proposed new NHS 111 non-emergency patient helpline is expected to include “an ongoing role” for NHS Direct alongside other providers, in line with an “any willing provider” approach, Health Secretary Andrew Lansley has said.
His comments come in a letter to Conservative MP Stephen Dorrell, chairman of the House of Commons Health Select Committee, who had asked him for clarification of the government’s plans for NHS Direct after it was widely reported that the helpline was to be closed and replaced by the new NHS 111 service.
Mr Lansley replies that the NHS Direct number – 0845 4647 – is to be phased out by 2013, so that there will be just two numbers for people to call: 999 for an emergency and 111 for non-emergencies. Until then, NHS Direct will continue to provide its current service.
“While its telephone number will no longer exist in the long term, we do expect an ongoing role for NHS Direct, alongside other providers, in delivering the NHS 111 service, in line with an ‘any willing provider’ approach,” he adds.
Moreover, the Care Quality Commission (CQC) will be asked to clinically assure future providers of NHS 111 and ensure they meet the national service specification, he adds.
The first NHS 111 pilots, now underway in the north of England, will run for 12 months, and an evaluation by the University of Sheffield will be made available in November 2011. The number of pilots will be increased, and a minimum dataset will be produced and made available to GP consortia, says Mr Lansley.
The government also wants to assess the pilots’ impacts on the wider health economy, as patients should feel able to call 111 when they do not know where to seek help. This will enable commissioners to make informed decisions about how NHS 111 is delivered, and how the service fits into their local urgent-care systems, he adds.
Mr Dorrell’s letter also asks about employment plans, pointing out that NHS Direct currently has around 3,400 staff of whom 1,400 are nurses, and wondering if the government plans to staff NHS 111 in a broadly similar way.
In his reply, Mr Lansley says that there will not necessarily be a “one size fits all” approach to staffing NHS 111; the most appropriate staff mix for call-handling “must be evidence-based and reflect the needs of commissioners, which is exactly why we are piloting the service,” he writes.
38% of staff at the current NHS 111 pilot site in County Durham and Darlington are trained nurses, compared to 48% in NHS Direct’s 0845 4647 service. “This assessment system requires a smaller proportion of nurses to call handlers and is based on clinical evidence supported by many of the major royal colleges, “ writes Mr Lansley, but, he adds: “if a caller to any NHS 111 pilot needs to speak to a nurse, they will speak to a nurse. Likewise, if a caller needs to see a doctor, the service will arrange for them to see a doctor.”
Mr Dorrell also asks whether NHS Direct is included in the QIPP (Quality, Innovation, Productivity and Prevention) programme of efficiency savings and, if it is, what are the targets it is seeking to achieve. Mr Lansley replies that while the service is not part of QIPP, the operating costs of NHS Direct’s 0845 4647 service have reduced significantly over the last two years, with a drop in the contract value from £136.5 million in 2009-10 to £123.3 million in 2010-11. “Through its commissioner, we will continue to expect further efficiencies in future years,” he adds.
“NHS 111 is a free-to-call service, available through the easy-to-remember three-digit number,” Mr Lansley writes. “It will provide a more comprehensive service by providing consistent clinical assessment of patient needs and using a comprehensive directory of service to ensure they are sign-posted to the service that is best able to meet these needs, taking into account their location, the time of day and the capacity of local services. It will also deliver an improved telephone service, by booking appointments in the appropriate service and eliminating call-backs, wherever possible,” he tells Mr Dorrell.
