BMJ  2006;332:305 (4 February), doi:10.1136/bmj.332.7536.305

Letter

NHS Direct did not emerge from an evidence free void

EDITOR—The claim by McDonnell et al, that the implementation of NHS Direct ran ahead of the evidence has little basis.¹

Preceding the observational study cited by McDonnell et al, a wide range of evidence existed about the successful operation of similar services both in the United Kingdom and internationally.^{2 3} There was also survey evidence of strong public demand for such services, plus additional design and evaluative work.⁴

The observational study provided valuable information about the limited initial impact of NHS Direct on immediate care but was not focused on measuring wider impacts such as general practitioners' routine consultations. Useful evidence on these was, however, provided by survey and monitoring work. These indicated that a sizeable proportion of callers appeared to be contacting NHS Direct instead of their general practitioner.

McDonnell et al say that one finding of the National Audit Office study of NHS Direct, that not all of the helpline spend is offset by encouraging more appropriate use of NHS services, raises questions about the remaining £45mn ($80m; 65m).¹ The National Audit Office, however, raised no such concerns, presumably because £1 net per head per year was recognised as good value for a highly popular 24/7 information and advice service. The overall conclusion was that the implementation of NHS Direct so far has been a success.

McDonnell et al note that NHS Direct is associated with high consumer satisfaction, but so are most health services.¹ The caller satisfaction ratings for NHS Direct have been consistently around the 95% mark, extraordinarily high even for a health service. (User satisfaction levels on general practitioners' services and inpatient services tend to run at around 85% and 70%.)

It is instructive to compare the position on speed of implementation and availability of evidence for the NHS Direct helpline with that for NHS Direct Interactive, the recently launched digital TV service. Here the starting position was quite different. No experience of such services existed in the UK or internationally, so there was no prior evidence. In this case therefore the Department of health established an extensive pilot programme that was thoroughly evaluated before any implementation decisions were made.⁵

Department of Health, Leeds LS2 7UE geoff.royston{at}dh.gsi.gov.uk

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Competing interests: None declared.

References

1. McDonnell A, Wilson R, Goodacre S, (2006). Evaluating and implementing new services, BMJ 2006;332: 109-12. (14 January.)[Free Full Text]
2. Lattimer V, George S, Thompson F, Thomas E, Mullee M, Turnbull J, et al. Safety and effectiveness of nurse telephone consultation in out of hours primary care: randomised control trial. The South Wiltshire Out of Hours Project (SWOOP) Group. BMJ 1998;317: 1054-9.[Abstract/Free Full Text]
3. Balas EA, Jaffrey F, Kuperman GJ, Boren SA, Brown GD, Pinciroli F, et al. Electronic communication with patients: evaluation of distance medicine technology. JAMA 1997;278: 152-9.[Abstract]
4. Royston G, Halsall J, Halsall D, Braithwaite C. Operational research for informed innovation: NHS Direct as a case study in the design, implementation and evaluation of a new public service. J Operational Research Soc 2003;54: 1022-8.[CrossRef]
5. Nicholas D, Huntington P, Williams P, Gunter B., First steps towards providing the UK with health care information and advice via their television sets: an evaluation of four Department of Health sponsored pilot services, ASLIB Proceedings 2003;55(3): 138-54.

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