GP triage and the case of NHS 111

A small study can sometimes have a greater than expected impact. Here’s a case in point – over the weekend, unexpected press coverage came our way over the fact that (in the words of the Daily Mail) there is an “NHS 111 farce” as “75% of patients referred to A&E do not actually need to go”. A study by Martin Roland (co-director of CCHSR) and Andrew Anderson (of Cambridge and Peterborough CCG) had been picked up by various media channels, including The Times and The Independent. Published in BMJ Open, this small-scale study considered the effect of using experienced GPs to review the advice given by NHS 111 call handlers. The GPs reviewed 1474 cases in which NHS 111 decision support software would have advised the caller to attend A&E. For 400 of these cases (27.1%), the GPs also decided A&E was the recommended course of action. But it turns out other care options were indeed available – so GPs recommended a primary care out-of-hours centre or minor injury unit for 665 cases (45.2%), and self-management or an alternative strategy for 409 cases (27.8%).  The Daily Mail concluded that NHS 111 call handlers were “needlessly sending hundreds of thousands of people” to A&E. In slightly more measured tones, alongside lots of caveats about the local and observational nature of the study, the paper concluded that “the study suggests that there could be substantial benefits, and possible cost reductions, by engaging experienced GPs in out-of-hours triage decisions within NHS 111.” And asked for more research, of course.

Anderson A, Roland M. Potential for advice from doctors to reduce the number of patients referred to emergency departments by NHS 111 call handlers: observational study. BMJ Open 2015;5:e009444.doi:10.1136/bmjopen-2015-009444


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  • The Cambridge Centre for Health Services Research (CCHSR) is a thriving collaboration between the University of Cambridge and RAND Europe. We aim to inform health policy and practice by conducting research and evaluation studies of organisation and delivery of healthcare, including safety, effectiveness, efficiency and patient experience.