25 January 2012

NHS 111: Getting Lost in Translation?

The new urgent care telephone number NHS 111 may have the potential to bring real benefits to the health care system but, according to a recent NHS Alliance survey, is in danger of ‘getting lost in translation’. The 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 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, which can be used to address clinical leaders’ concerns and boost the level of local engagement and influence.

  • 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.

Notes:

  1. NHS 111: getting lost in translation?has been published by the NHS Alliance Urgent Care Network and the Clinical Commissioning Federation. The Urgent Care Network represents the wider sector and is made up of 12 elected representatives, including chief executives and medical directors from urgent care providers. The Clinical Commissioning Federation is made up of CCG leaders and their wider CCG membership of those involved in clinical commissioning.
  2. NHS Alliance brings together GP consortia, PCTs, clinicians and managers as the leading organisation in primary care. We are an independent non-political membership organisation proud to be at the forefront of clinically-led commissioning. Its leaders are all dedicated professionals, who represent the Alliance’s diverse membership, working ceaselessly to meet the challenges facing the NHS today. Find out more at www.nhsalliance.org
  3. The NHS Alliance produced a resource for local urgent care commissioners in December 2011 – Breaking the Mould without breaking the system: new ideas and resources for clinical commissioners on the journey towards integrated 24/7 urgent care.  For a copy, please email pressoffice@nhsalliance.org. In June 2011 an earlier discussion paper, entitled A new approach to 111: re-establishing general practice as the main route in to urgent care, called for greater flexibility in implementing NHS 111.
  4. For more information, please email pressoffice@nhsalliance.org or call 07772756674.