Three quarters of 111 A&E referrals ‘unnecessary’

George Underwood

Nearly three quarters of A&E referrals from NHS out-of-hours calls are unnecessary, according to a new study.

The research, published in BMJ Open, attempted to determine the effect of using GPs to review the advice given by call handlers on the 111 service when they recommended the patient attended A&E.

GPs only backed this recommendation in 27 percent of these cases; in the remainder they either recommended attendance at a primary care out-of-hours service or minor injury unity (45 percent), or self-management or an alternative strategy (28 percent).

The authors conclude that “the criticisms that NHS 111 sends more patients than necessary to A&E departments therefore appears correct”, although they caution that they were not able to assess the appropriateness of decisions made by either the GPs or the call handlers.

Moreover, as only 6 percent of A&E attendance occurs as a result of 111, the overall impact on the NHS of restructuring the service would be relatively small.

Analysing the results of a separate review published today, NHS England itself said that service could actually help to take the pressure off frontline A&E and ambulance services – one survey found that in 91 percent of paediatric cases analysed, the callers fully followed the advice of action received.

Overall the review found “excellent” satisfaction ratings for out-of-hours services. One survey in North West London found that 84 percent of people calling the helpline ‘got what they needed’, while 80% said they would call NHS 111 again if they had the same problem.

In a statement Professor Maureen Baker, chair of the Royal College of GPs, and Dr Clifford Mann, president of the Royal College of Emergency Medicine, said: “We need public awareness campaigns to tell people about the range of services that are available to patients out of hours, and how to access them, as a matter of urgency.

“Our Colleges will work together to ensure that decisions about urgent care services are made in the best interests of local populations. In areas conveniently served by an A&E department co-location of primary care services on the same site is an example of streamlined service configuration.

“Our Colleges both understand that the most cost-effective form of care is general practice and that investing in general practice services – in and out of hours – and making these services more integrated will alleviate pressures across the health service, including emergency departments.”

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