News Roundup [abridged Versions Appear In The Paper Journal]

NHS Direct underused by ethnic minorities

BMJ 2002; 324 doi: (Published 26 January 2002) Cite this as: BMJ 2002;324:190
  1. Alex Vass
  1. BMJ

    NHS Direct, the telephone healthcare service operated by nurses in England and Wales, is used less by ethnic minorities, people aged over 65, and disadvantaged groups than by the general population, a new report about the service in England has said. Yet these groups had “as much need as others and perhaps an even greater one.”

    The report, published today by the National Audit Office, says that the service is nevertheless operating safely and effectively. Its report details only 29 cases of adverse events in the past three years—less than one in every 220 000 calls.

    The impact of the service has also reduced demand on healthcare services that are provided outside normal working hours—by GPs, for example. The report says that one GP cooperative providing out of hours services had seen an 18% fall in the number of calls received, when callers were transferred to NHS Direct first.

    The service was underperforming in some areas, however. Although few callers received an engaged signal, only 64% of callers managed to speak to a nurse within five minutes. The target set by the government was 90%. One in five callers had to wait more than 30 minutes for a nurse to call them back.

    The number of calls is expected to double over the next year. The report says that longer term strategic plans were needed for dealing with this expected increase, including a staffing strategy to help achieve the number of nurses required without exacerbating nursing shortages elsewhere in the NHS.

    Currently 1150 nurses are employed in the service. The NHS introduced a range of initiatives to reduce the impact of nurses leaving the NHS to work for the telephone service—including the establishment of part time work to allow its nurses also to work in the NHS.

    NHS Direct is the largest provider of healthcare advice in the world. The service has been fully available in England and Wales since November 2000. In 2000-1 it received a total of 3.5 million calls and cost £80m ($112m; €128m) to run.

    About half this cost, the report suggests, has been offset by encouraging more appropriate use of NHS services, including advising callers who would normally visit their GPs on how to care for themselves.

    John Bourn, head of the National Audit Office, said: “It was a significant achievement getting NHS Direct up and running in less than three years. The service is valued by those who use it and, according to the evidence available, is starting to meet its aim of directing people to more appropriate forms of healthcare.”

    Report by the Comptroller and Auditor General: NHS Direct in England is available from 25 January on the National Audit Office's website (

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