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NHS 111 - data errors from the BMA

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The BMA have made mistakes in their press release today.  We have all done this, but it is unfortunate if it undermines the case.  There is a real debate to be had about NHS 111 - but the claim that 'the number of calls referred through to GP services had gone up by 186% and to A&E by 192%' is not right.  Actually the growth figures are 39% and 43% respectively*.

 But even this does not present a realistic figure.  There are two things that they are ignoring.  First that the roll-out of NHS 111 was phased over a period so that the population covered has grown.  If we compare the figures per 1000 population we find that the growth is something near to 30%.  Second fewer of the out of hours services were fronted by NHS 111 in October 2013 than by October 2014 - and since the volume of out of hours calls is large, this makes quite a difference.  To make a proper comparison they should be looking at those areas where the volume of calls has not been increased by changes to the operational model of the urgent care system like this.

 There is another over-simplistic comparison when they say 'In its final full year of operation in 2011/12, NHS Direct received 4.4 million calls from patients. November 2014 figures show that NHS 111 has received and responded to over 12.4 million calls in the calendar year– an increase of around 250 per cent in comparison to the previous 0845 number'.  This ignores completely that in 2011/12 the out of hour services would have been receiving something over 7 Million calls a year.  Add this to the 4.4 Million for NHS Direct and you are approaching the 12.4 Million that they quote for NHS 111 - and bear in mind that at least one of the aims of NHS 111 was to offer an alternative to patients that might otherwise have used 999 so we might expect some growth.

 And finally they have compared the figure from our benchmark of out of hours services for 'advice' which includes advice to go to A&E, call the ambulance and more with NHS 111 self-care advice - another misleading comparison.

 I hold no candle for NHS 111.  We should be having a debate about it.  We should be discussing the high levels of referral to A&E and ambulance services compared with the previous model; we should be looking at the occasional long delays in transfer to out of hours services; the proportion of NHS 111 priorities that are escalated or downgraded; we should be looking at the differences between dispositions between one provider and another and we should be looking at alternative models and ways of working that will help to alleviate the pressure on the urgent care system. 

If the BMA can act as a catalyst for informed discussion that leads to these issues being addressed then their careless error will be forgotten.

 

 *It looks as though the BMA compared figures for the total from the initial pilots to October 2013 with the total, again from the initial pilots, to October 2014.  They have since provided a correction, but have chosen to compare the Nov 2012-Oct 2013 with Nov2013-Oct 2014.  Since most NHS 111 sites did not become active till part way through the first period there is no real comparability.

 

 

 

 

 

 

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After a background in manufacturing organisations including roles as operational manager, accountant and general manager, Henry has spent some 20 years as a consultant to organisations in both the private and public sector. Much of this work has involved the specification and commissioning of a range of public sector services from benefits, through support services including (for the NAO) a review of the way in which IT services were outsourced by the Inland Revenue to primary and secondary healthcare services. He has advised the Care Quality Commission and the Healthcare Commission not just on their investigations into specific cases (such as the investigation into Take Care Now) but also in their wider evaluations of value for money (such as the report 'Not just a matter of time' into GP out of hours services). A particular interest is in making sure that the data collected through systems is useable and used to support improvement of the service. Work within the acute healthcare sector has involved him in A&E, Urgent Care services of all types, Diagnostics and Pathology, IT systems , Imaging, Medical assessment as well as in Health Insurance. In Primary Care, Henry has worked with many Out of Hours providers, particularly in benchmarking their performance and looked at the operation of numerous general practices, Walk in Centres and Minor Injury Units. He has also worked with Practice Based Commissioning groups looking to specify services, groups of GPs forming provider service organisations and in looking at mutual and social enterprise models of provider.

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Guest Friday, 22 June 2018

About Us

The Primary Care Foundation was established to support the development of best practice in primary and urgent care.  The three Directors bring different skills and perspectives to understanding primary and urgent health care - for more details click below:

David Carson

Rick Stern

Henry Clay

 

 

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The Primary Care Foundation were selected by NHS England to further improve and automate the audit of potentially avoidable appointments. We are now building a new website with Method Analytics that will make it much easier for any practice to register online, will simplify data collection for clinicians, and will allow for instant reporting on results. The reports will be much easier to understand and will signpost other support. And it will remain free to use for all practices in England.

We are now ready to go live with a new ‘test’ site. We are confident it is already easier to use but we are keen to get any feedback from practices before the new website is fully up and running.

If you are a practice in England and you want to register, CLICK HERE  and click on ‘register here to create a practice audit!’ You will be guided through registration and how to set up your clinicians to take part in the audit.  This is a new test site, so if you notice anything that doesn’t look right, or could be made easier, just let us know.  And the same for your clinicians as they enter data – any feedback at the moment – good or bad – would be really helpful … just email us This email address is being protected from spambots. You need JavaScript enabled to view it.

 

What do we mean by an ‘avoidable appointment?

The latest blog by Rick Stern ‘If only …’ explores the idea of avoidable appointments, what practices have gained from the audit, and what might be possible with further investment in general practice. It is available HERE and will also be published in Health Care Leader.

 

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A feature article in Management in Practice by Rick Stern reviews what we have learned from working with over 1,500 practices across the UK – you can read the full article HERE  

 

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A lead article for Health Care Leader by Henry Clay describes a financial and capacity model developed for NHS England, the potential benefits and pitfalls, and what we have learned from working with a dozen areas to apply the model. The article is available at HERE and a fuller version with a number of explanatory graphs can be downloaded HERE

 

Integrated Urgent Care – opportunity for support to your locality

We have developed a financial model for the Integrated Urgent Care Team at NHS England that focuses on the NHS 111 and OOH ‘front end’ to an integrated urgent care system (but also looks at the cost of onward referrals to other services). This is proving to be an invaluable tool for both commissioners and providers. It is now available to use and NHS England have also agreed to support some sites to setup and work through the model with PCF’s Henry Clay who developed the model. For further information please contact Henry on This email address is being protected from spambots. You need JavaScript enabled to view it.

 

We are now supporting over 1,500 practices across the UK to manage access and urgent care

Our support for general practices looking to improve access for patients and streamline the management of urgent care continues to expand. Based on a web based tool, developed out of our work commissioned by the Department of Health, we collect practice data for one week and prepare a report for each practice looking at how you compare to others and explore what this means for making practical changes in the way you work. We are regularly improving the format of our reports for practices based on constant feedback. If you would like to see an example report, CLICK HERE.  If you want to know more about how we might work with you please contact Rick Stern on  This email address is being protected from spambots. You need JavaScript enabled to view it.  or call on 07709 746771.