If It Ain’t Broke, Don’t Fix It – A Lesson From NHS Direct (Part 3/4)

This is part 3 of this article. It won’t make much sense unless you read Part 1 and Part 2.

This wouldn’t actually bother me too much if NHS 111 was better than NHS Direct used to be. Well guess what? It isn’t. Remember the criticisms that I mentioned about NHS Direct – one being that it was too cautious and just sent everyone to the GPs anyway? Bearing that in mind, here’s a quote from Dr Chaand Nagpauls, head of the British Medical Association’s GP committee, made on the 21st May 2015.

‘NHS111, which last year referred 5m more patients to general practice, clogging up our appointments, and with only 15% of patient managed with self-care compared to a 48% previously. This comes as no surprise with a system relying on computer algorithms – not clinicians – to give advice.’

If 15% GP referrals was too cautious, what in the name of David Cameron’s incredibly shiny forehead is 48%? That makes Neville Chamberlain look at Atilla the Hun. Here’s another quote made last year by Dr Nagpauls:

NHS 111 continues to provide a variable and often inadequate call handling and triage system, and will impact on the ability for GP out-of-hours services to provide optimal care.’

Fancy some examples to back that up? Well here’s an article detailing how pensioners were asked ‘are you conscious?’ by call handlers, and another detailing how a lady who couldn’t get through to NHS 111 ended up going to A&E anyway. The kicker about that last one? The GP involved with the case was Dr Laurence Buckman, the previous chair of the BMA GP Committee. When two successive chairman of the committee dedicated to the countries biggest primary care specialty are critical of you, it may be time to start doing things a little differently. 

OK, so many more patients go to GPs unnecessarily, but at least they’re not ending up in A&E, right? Err…no, in fact here’s an example from Staffordshire where more patients are going to their local A&E due to advice from NHS 111. My favourite quote from the story ‘It’s quite obvious to me that the people who are being trained to answer the phones do not have sufficient clinical knowledge to take those calls.’ For anyone concerned, I’ve cherry picked an isolated case, here’s the President of the College of Emergency Medicine saying NHS 111 may be contributing to winter pressure on A&E. Hopefully, his talkinge knows what 

OK, so maybe GPs are getting more visits. And yes, A&E are getting more visits than they should. But at least people aren’t dying unnecessarily? Well here’s four headlines I found in less than 30 seconds of searching 

Distressingly, the fourth headline isn’t just about those three deaths. The main story also discusses 19 ‘untoward incidents’ since the service was rolled out nationally the month before. Twenty two serious incidents is hardly the best of starts. And why might people be dying unnecessarily? Perhaps because the minimum you need in some areas to work as a 111 call handler is a Maths and English GCSE. I might apply. I could do with some cash and I’m vastly overqualified if that’s the minimum standard. 

Here’s the fourth and final part of this article.


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