75 per cent of NHS 111 A&E referrals unnecessary

The research, published in the ‘BMJ Open’, found 1,474 cases where lay 111 call handlers had sent patients to A&E, where triage carried out by a GP would have resulted in only 400 patients being referred.

NHS 111 relies on lay-call handlers triaging patients using the NHS Pathways algorithm to determine where a patient should be sent. The study’s authors outlined it was ‘ironic’ that urgent care triage is increasingly run by those with the least clinical experience.

The figures suggested 45 per cent of patients directed to A&E by call handlers could have been seen in out-of-hours or by a minor injuries unit, while 28 per cent could have been advised to self-manage, or use a non-urgent service.

NHS England agreed that the findings demonstrated GP triage would have significant benefits, however more investment in primary care was necessary to enable this as the current GP workforce was insufficient.
The study did not measure the actual clinical outcomes of patients, the eventual action patients took, or the cost effectiveness of each outcome.

However, the report estimated a cost saving for commissioners of £11,113 if GPs were employed in the call centres, comparing savings made for A&E with GP salary costs.

The report stated: “It seems ironic that at a time when out-of-hours primary care services have progressively moved to less skilled people handling calls (from doctors to nurses to call handlers), hospitals have done the reverse.

“NHS 111 will inevitably request a higher level of care than may be necessary in order to operate safely. 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.”

An NHS England spokesperson said: “Only around eight per cent of calls to NHS 111 result in advice to attend A&E. Despite increases in demand from the public for the 111 service, the proportion of referrals to emergency services remains steady.

“This study suggests that if more GPs were available it might be possible to reduce pressure on A&E, which is why we need to invest in primary care, not just A&E departments themselves.”

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