NHS 111: lost in translation?
Released 25/01/2012
Survey of clinical commissioners reveals lack of engagement
A survey completed by NHS alliance shows lack of engagement in the implementation of NHS 111, a national telephone number for patients who have an urgent but not life-threatening, health problem
A recent NHS alliance survey has revealed that clinical commissioning groups feel the new urgent care telephone number NHS 111 is in danger of “getting lost in translation”.
According to the survey, new clinical commissioners currently feel a lack of engagement with NHS 111, despite the fact that they are the key people responsible for its rapid implementation across England by April 2013.
The survey found that current clinical engagement appears to be poor and clinical leaders feel that this is another example of top down policy rather than local innovation.
Only 11% of clinical leaders stated they have experienced “good engagement; my view was taken into account”, with 32% saying there has been “some engagement, but no real ability to affect decision making” and 55% saying there was little or no engagement. Also, 77% of respondents said that “there is little scope for local clinicians to shape this service to meet local needs”.
Rick Stern, urgent care lead, NHS alliance, said: “We remain supportive of the idea and want to work in partnership with the Department of Health and other national partners to ensure that local commissioners are actively involved in the development of NHS 111.”
“However,” he added, “our members currently feel disengaged and believe there is little room for local flexibility. We need to take steps to address this now, as otherwise both the 111 programme and the credibility of local clinical commissioning will suffer. While there is support for NHS 111, in principle, there are substantial concerns about the speed and style of implementation.”
The survey highlights examples where local systems have decided to vary the way 111 is to be implemented locally as part of a clear view of how to develop integrated 24/7 urgent care. It also demonstrates that clinical leaders are wary of top down implementation.
One survey respondent said: “I have strong reservations about 111. The whole of the NHS reforms are being managerially-led and the clinically-led proclamations seemed to have been purely an aspiration which has now been all but sadly lost.”
Another added: “We started by considering a local pilot, but have been told it’s too much of a risk. The timetable for implementation is clearly driven from the top. We now must devote resource to ensuring it’s not going to destabilise our local urgent care strategy.”
Recommendations
In its discussion paper, the NHS alliance makes a number of recommendations, below:
- Support the Department of Health in its plans for an objective peer learning exercise amongst existing providers of current NHS 111 pilots.
- Offer opportunities for whole system support for everyone to discuss and agree on a way forward.
- Encourage local CCGs to take more active leadership of the process for introducing 111. If leaders feel blocked, or that they are simply being directed to support a regionally determined solution that doesn’t meet their needs, they need to speak out.
- Ensure that we make the best possible use of all information coming out of the formal independent evaluation of the first four pilot sites, as well as other intelligence from pilots and procurements across the country.
- Allow CCGs to ‘pause’ current procurement processes that have not yet been concluded if they feel that they have not yet built in enough local flexibility to existing specifications.
A DH Spokesperson said: "The NHS 111 services will bring significant benefits to patients and the majority of clinical commissioners are engaged with it. The pilots are enabling us to provide a basis for local design of solutions, and Clinical Commissioning Groups are already positive about how this will enable them to improve access to emergency and unscheduled care. We will ensure that although planning will go ahead for roll-out from April 2013, this will be achieved with CCGs in a leadership role."
Dr Brian Gaffney, Medical Director for NHS Direct said:
“The NHS Alliance survey reflects significant concerns from GPs about the level of clinical engagement in developing and commissioning NHS 111 services. These concerns need to be taken seriously, not least because Clinical Commissioning Groups (CCGs) will inherit NHS 111 contracts and be responsible for the service in their local area.
“GPs have highlighted there is ‘no real ability to affect decisions’ and there is ‘little scope for local clinicians to shape this service to meet local needs’. From our experience of leading four of the seven pilots, we know that local clinical engagement is imperative for NHS 111 to deliver benefits to local health economies.
“We know from our pilots that NHS 111 supports fewer patients to self-care than the 0845 4647 service, and refers more patients to face-to-face urgent care services. There is a danger of NHS 111 leading to substantial additional costs across the health system if it is not commissioned as part of the local urgent care services. The expertise for taking this forward lies with local clinicians and they need to be fully involved immediately.
“NHS 111 has the potential to improve access to urgent care and the actions proposed by the NHS Alliance need to happen very soon to influence the national roll out.”
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