News Roundup [abridged Versions Appear In The Paper Journal]

Demand exceeds capacity for NHS Direct

BMJ 2003; 327 doi: (Published 13 November 2003) Cite this as: BMJ 2003;327:1126
  1. Roger Dobson
  1. Abergavenny

    NHS Direct is now so popular, with one million contacts a month, that some call centres are facing capacity problems.

    According to a report by the health watchdog, the Commission for Health Improvement (CHI), some centres are missing, or close to missing, national targets to answer 90% of telephone calls within 30 seconds and to triage 90% of callers with symptoms within 20 minutes.

    The report, the first independent national assessment of the five year old service, says it provides good quality advice and reassurance and is appreciated by the people who use it.

    But demand is increasing, and the service handles 500 000 telephone calls and 500 000 internet inquiries a month across England and Wales.

    “Success, however, has meant increasing demand for the service and capacity problems for some call centres,” says Jocelyn Cornwell, acting chief executive of CHI.

    The report says that call centres, which advise on issues as diverse as fad diets, gout, and ovarian cysts, are nevertheless meeting the targets that 90% of health information calls should be assessed within three hours and under 0.1% of calls should receive the engaged tone.

    But Helen Parker, editor of the Consumers' Association magazine Which?, warns that the report does not reflect the whole picture.

    “Recent research carried out by Which? found NHS Direct staff frequently failing to spot potential emergencies and leaving patients waiting too long for medical advice,” she said. “Our investigation highlighted fundamental problems that the Department of Health must take seriously to ensure a safe, responsive, and reliable service.”

    A recent report by a national audit group of three hypothetical scenarios for the treatment of fever in children that were presented to 100 nurse advisers working in NHS Direct, found variations in their advice.

    “There was undertriage to non-urgent care by 12 per cent of nurse advisors for the urgent care scenario,” the authors concluded, adding, however, that none of the advice given was considered to be unsafe (Clinical Governance 2003;8:222-6).

    At the time, each NHS Direct site used one of three computerised decision tools. A fourth has since been implemented as the national standard across all sites in England, and the authors say this should help to improve consistency.

    CHI's report, What CHI has Found In: NHS Direct Services Sector Report, is available at

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