Intended for healthcare professionals


NHS England announces inquiry into ailing 111 service

BMJ 2013; 346 doi: (Published 03 May 2013) Cite this as: BMJ 2013;346:f2923
  1. Gareth Iacobucci
  1. 1BMJ

Providers of the new 111 urgent care telephone hotline should face financial penalties or even have their contracts revoked if they failed to demonstrate their ability to meet the required standards for the service, the deputy chief executive of NHS England has said.

Barbara Hakin told the organisation’s board meeting on 3 May that the service had been “undeniably unacceptable” in some areas and that clinical commissioning groups should impose tough sanctions on providers that could not demonstrate improvements against standards.

The warning came as NHS England announced an inquiry into the management and implementation of the non-emergency telephone service, which has been beset by problems since its launch on 1 April, with reports of inappropriate delays in treatment, slow response times to calls, and “severe pressure” on emergency departments.1

In papers accepted at its board meeting,2 NHS England reported that the target to answer all 111 calls in under 60 seconds was “still a struggle for a number of providers” across the country and that the service was “still fragile in a number of areas and many have needed contingency.”

It did, however, report a “vastly improved picture” in comparison with the Easter bank holiday, with most providers now meeting the target that fewer than 5% of callers should abandon their calls before they were answered. NHS England said that it was keeping a close eye on the performance of providers and commissioners and pledged to review the rollout of the new system to determine “lessons learnt.” Its review would scrutinise the scope and design of the service, examine whether the commissioning model was appropriate, and look at whether it was necessary to “manage the market in order to secure a full range of capable and sustainable providers,” it said.

It added that it would work with clinical commissioning groups to “stabilise those providers that have failed to deliver their 111 service as well as ensure that those areas yet to go live are in a safe, and fit, state to do so.”

Hakin said that 90% of the country was now covered by 111 but that there would be “no further rollout in any area until we are satisfied that that rollout can be delivered safely.”

The board said that its actions were designed to ensure safe rollout of 111 across England by the end of the summer.

Hakin said, “Some providers have not been able to meet the key standards set for them. That has been undeniably unacceptable in some places. Some of our providers let us down very badly.”

But she added, “It is important to remember in most areas 111 has provided a very good service to patients. We have seen a very significant improvement from three or four weeks ago.”

Hakin said that clinical commissioning groups could impose “financial penalties where services haven’t been of a standard or revoke the contract where the providers have not been able to show they can improve on the standards.”

She added, “In certain areas those financial penalties have been brought into play. But we will have to measure the balance between continuing to support a provider and looking at an alternative.”

Hakin said that the external review of the rollout would look at the whole process of commissioning the service.

“The board asked we put in place a review to identify what lessons we can learn from this, in terms of the commissioning of this service. How was it possible to award contracts to providers who so patently couldn’t deliver the service on day one?” she said.

Speaking on Radio 4’s Today news programme earlier in the day, a Salford GP, John Hughes, said that most of the NHS 111 services in Greater Manchester had been abandoned 10 hours after they launched because too many patients were being sent to hospital emergency departments. He said that the review should have started six weeks ago when the “disastrous” system collapsed.

Hughes said that “the procurement, spending, and exactly what went wrong” warranted a public inquiry by the parliamentary health select committee or public accounts committee because of the amount of public money that had been spent on NHS 111.


Cite this as: BMJ 2013;346:f2923


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