NHS 111 - the government’s new urgent care hotline – is not just in trouble in Wiltshire

Written by Tony Millett.

LATE NEWS: On Tuesday (March 26) PULSE claimed that the launch of the NHS 111 service has been delayed in more than half of the country - with existing our-of-hours services and outgoing NHS Direct staff providing emergency cover or back-up.

As Marlborough News Online reported last week, the launch in Wiltshire of the new NHS 111 urgent care hotline replacing NHS Direct has been postponed for a month so that serious problems with the service can be ironed out.  It is now clear that it may not be just the private care company Harmoni that’s at fault but the system itself.

The triage programme has been designed centrally and signed off by the Department of Health. It relies on a computer-based system of keywords which will tell the telephone operator what sort of response is needed to the symptoms a caller describes.

During the ‘soft’ launch or live testing of the service in Wiltshire there were numerous examples of ambulances being sent out needlessly to patients by NHS 111 operators. And it is clear also that at the start of the test period the target period of time in which calls should be answered was achieved only in a great minority of cases.

The report on the service’s failings in the doctors’ journal PULSE at the end of last week was headlined: “NHS 111 implodes as GPC withdraws support for urgent care hotline.”  The ‘GPC’ is the General Practitioners’ Committee of the British Medical Association (known more generally as the BMA.)

Pulse reported problems in South London (a ‘shambles’), Manchester (the out of hours service took the calls back from NHS 111 during its ‘soft’ launch) and Birmingham. Their report attracted four pages of comments from Pulse’s readers.

According to one anonymous post: “It is a dangerous disaster waiting to happen” and it was taking up to an hour to triage complex cases.  The complainant explained that with the computer formula: “If certain 'key words' are used by the callers such as ' I've been coughing and have a TIGHT chest' this will trigger a 999 call. The Ambulance Service will grind to a halt.”

This post ended “I retire early in two weeks time. Good luck to those left to carry on.”

An anonymous doctor wrote: “The final level of abandoned calls last night in the North West 111 service was 69.7 per cent!!! This is against the average 1-2 per cent experienced by local out-of-hours providers for years.  We used to pick up calls within sixty seconds and identify life threatening conditions within three minutes. Again standard for out-of-hours providers.  Last night [a Thursday] the 111 provider was not answering for 45-90 minutes at times. What will happen on a Saturday morning or a fourth day bank holiday?”

As the contractor for Wiltshire’s NHS 111 service, Harmoni will have to sort out the problems before the service in our area can be launched safely.  Since the contract with was signed, Harmoni has been bought out by Care UK and it is understood that Jim Easton, Care UK’s

Managing Director of Health Care, is taking a personal interest in the problems in Wiltshire. Mr Easton was previously the Department of Health’s National Director of Improvement and Efficiency.

One correspondent reacting to the report in PULSE asked why this situation was not being reported in the national press.