NHS to revamp 111 helpline after sustained criticism of service

The NHS is to revamp its heavily criticised 111 telephone helpline to ensure that many more people get to discuss their illness with a nurse, doctor or other health professional rather than a call handler.

GPs and mental health health nurses will also start to play key roles after the overhaul, which is intended to improve public confidence in 111 so that fewer patients visit A&E or a GP’s surgery.

The changes, which will be unveiled later this month, are part of a major effort by NHS England to better integrate 111 with its other urgent and emergency care services, including ambulances, out-of-hours GPs and walk-in centres. It envisages the improved 111 service being a central part of such care, which it wants to become “the front door of the NHS”.

NHS 111 has faced sustained criticism since it replaced NHS Direct as the health service’s telephone advice line in 2012 as part of then-health secretary Andrew Lansley’s controversial shake-up of the NHS in England.

Simon Stevens, NHS England’s chief executive, last month admitted that “substantial changes” to 111 were needed. A&E doctors claim it has not kept the pressure off emergency departments while NHS ambulance services believe call handlers order ambulances for too many patients who do not need one.

NHS 111 uses far fewer nurses each year to answer callers’ queries about their symptoms than NHS Direct did. Despite that, the number of people seeking help from 111 has risen from 5 million a year when NHS Direct existed to 14 million now.

But under the imminent overhaul, which is due to be phased in across England from next month, about 30% of callers will speak to a health professional through a newly created Clinical Assessment Service.

“It’s clear the current 111 system isn’t working as well as it could due to a lack of trained clinicians,” said Anna Crossley, the Royal College of Nursing’s professional lead for acute, emergency and critical care, who has helped devise the revamp.

“A script and a call handler can’t replace the knowledge of a skilled, experienced nurse, someone who can spot serious conditions and ensure people receive the treatment or advice they need.”

NHS England expects the changes not to make 111 any more expensive to run because health professionals will be seconded or loaned to it, mainly by hospitals. But costs may rise if more staff end up being paid overtime for shifts answering calls. Callers should also be able to speak to a paediatrician, dentist, cancer nurse or social worker, depending on the nature of their problem and the staff available.

Stevens is likely to cite the revamp as proof that he is making good on his pledge to transform patient care by 2020, when he launches his long-awaited “delivery plan” later this month.

The Royal College of Emergency Medicine, which represents A&E doctors, said the overhaul of 111 should ease the strain on overcrowded emergency departments.

“The improvements being made by NHS 111 are very welcome,” said Dr Taj Hassan, the college’s president. “We know that currently at least 8% of all calls to NHS 111 are referred to emergency departments – a figure the college suspects to be significantly higher – and we hope by introducing more clinicians to the service, this figure can be reduced.

“From an emergency medicine point of view one of the key problems with NHS 111 was that staff, often with a limited medical background, work with a computer system providing a virtual checklist to help diagnose the patient’s problem,” he added. “With access to further clinical support being limited, when the call handler was still unsure of the problem they would, understandably, refer the caller to A&E to be on the safe side.

“The new service will have expanded clinical back-up for call handlers to refer to for guidance, or to pass the caller on to an experienced clinician, meaning better quality of care for patients. These ‘clinical hubs’ will not just support patients and NHS 111 call handlers, but also provide support and advice to clinicians and ‘field staff’ such as paramedics.”

Dr Helen Thomas, NHS England’s national medical adviser on integrated urgent care, said: “During 2017 we will make it possible for up to 30% of NHS 111 callers to have a telephone consultation with a clinician who will have access to medical records and be able to book them into an appointment if required.”

NHS to revamp 111 helpline after sustained criticism of service

BMA calls for helpline for people addicted to prescription drugs

The British Medical Association (BMA) has called for a 24-hour helpline to be introduced for patients who are addicted to prescription drugs.

The group believes it could help to tackle problems created when strong tranquillisers prescribed for short-term use, to treat issues such as anxiety and insomnia, are issued for longer periods.

Dr Andrew Green, the BMA’s GP clinical and prescribing policy lead, described dependence on the powerful prescription drugs as a widespread problem that sometimes involves patients who are upset at having been harmed by treatments they hoped would help them.

Dr Green said services need to be specifically designed for this group of people as they may feel out of place if they are referred to existing services, which are aimed at cocaine or methadone users.

He told BBC Breakfast: “The situation has been made worse because they have come to the NHS for help and they have found that the services are not available for them.

“We have even had some patients say they feel they are being blamed for the situation that they find themselves in.”

Benzodiazepines – taken for severe anxiety, insomnia and sometimes pain relief – are a particular concern. Disturbed sleep, personality changes, blunted emotions and people feeling they are struggling to manage their lives are among the potential side-effects of the drugs.

BMA calls for helpline for people addicted to prescription drugs

A letter to Steve, a helpline Samaritan

I have been which means to write to you for a prolonged time. In reality, for much more than twelve many years. Way back in September 2001 my son somehow managed to get you on a helpline in the Uk. Not effortless, as you know, due to the fact I dwell in Hong Kong. My son spoke to you about my out-of-manage alcoholism and drug addiction and asked if you could support. You said you would attempt.

When you phoned me later on that day I was in my workplace, stoned out of my mind with a heap of white powder and a bottle of booze on my desk. It was late in the evening and I was alone. Your call came out of the blue.

You might not have realised it (I anticipate you did, though) but I was significantly considering of ending it all. I just could not cease my self-destruction. I could not deal with my shame, my fears, my resentments against family and colleagues and I saw no way out. When you explained: “Peter, you don’t know me, but I have just spoken to your son. Are you Ok? How are you?” I had to cease myself from weeping.

In that moment (I didn’t know at the time why) I knew you were the 1st person I would spoken to who understood my pain and helplessness.

You then telling me that you were a recovering addict/alcoholic and had when gone through the identical horrors registered with me like nothing at all else had ahead of. I know today that, rather than supply me sympathy, you have been giving me empathy: a single of the most essential factors recovered addicts can provide every single other. With out it my recovery might have been extremely hard.

At the time, I was amazed that you had known as me from 6,000 miles away and that you did not reverse the costs that you did not request me to get in touch with you back on my very own dime.

Following listening to you, speaking to you, identifying with you in excess of people 50 or so minutes, I knew I had to do something about my existence of addiction. I knew I had to quit the carnage the discomfort I was leading to my family members, my pals, myself. I also believed you when you stated it was attainable to end “employing” and drinking and remain stopped. But that I had to take action and have some faith and trust and courage for the first time for many years.

In quick you “reached out” and I received the message – if I took action (by way of a twelve-step fellowship) and had an sincere want to get “clean and sober”, my daily life would modify so positively that I would be totally surprised.

You have been correct. You did not exaggerate. As you mentioned, addiction is the only illness in the planet exactly where, when you are in recovery, you come to feel greater than you did just before you acquired the sickness.

Inside 10 days of our conversation, and with my son’s assist, I was in rehab. I have to admit I did not end using in the course of individuals ten days and I turned up at the remedy facility totally drunk. But because I checked into the clinic that day, I have not had a drink or a drug and my life has modified beyond my wildest dreams.

I believe in a increased power. I realized (as you informed me), that I was the difficulty, that the booze and the medication have been the signs and symptoms that abstinence was the answer but to obtain this my contemplating had to alter in a lot of techniques. So I did what I necessary to do. I worked tough. I received truthful. I started out to care.

Each and every year brought me a lot more stability and happiness and significantly less self-centred, obsessive behaviour. My need to use thoughts-altering substances has been removed. I’ve grown up. I have faced my demons. I have after far more a loved ones that loves me. In brief, I have a “daily life”.

I did phone the helpline variety on which my son had spoken to you on but you had been no longer there. I did not consider to track you down. Maybe I need to have, but I did not think which is what you necessarily wanted. You were “carrying the message” to me as you must have to a lot of other people. By this letter, I want you to know my gratitude to you for reaching out to me – a stranger – and, by undertaking so, affecting my existence so considerably for the much better.

I will be 13 years sober in a number of months. To you, and all individuals who have helped me on my journey, thank you sincerely.

Ideal wishes, Anonymous

A letter to Steve, a helpline Samaritan