Intended for healthcare professionals

Letters GPs and emergency care

A single practice’s experience of NHS 111

BMJ 2014; 349 doi: (Published 13 August 2014) Cite this as: BMJ 2014;349:g5034
  1. M O Thompson, foundation year 2 doctor, Defence Postgraduate Medical Deanery, Defence Medical Services and Peninsula Foundation School1,
  2. R C M Jones, GP and Plymouth University Peninsula Schools of Medicine and Dentistry1
  1. 1Armada Surgery, Plymouth PL1 5AJ, UK
  1. michaelthompson1{at}

The joint report discussed by Iacobucci says that NHS 111 and equivalent telephone advice services may help to reduce the pressures on the urgent and emergency care system.1 The general feeling is that the NHS 111 service has only served to increase pressure on already overstretched urgent care services, particularly ambulances and emergency departments.2 3 4

To assess how the service works in our small inner city practice (n=2611), we reviewed all 228 interactions with NHS 111 from July 2013 to May 2014, accessing practice records to identify subsequent management of the problem recorded in the 111 reports.

The mean number of calls per month was 26.8 (remaining stable since inception). Of the 228 calls, 154 were for those aged 19-69, 70 being for those aged 19-29 and only 20 for those aged 70 and over. Of the 228 callers, 130 were advised to seek GP advice and 24 were advised to manage their problem at home. Only 15 callers were advised to attend an emergency department, with a further 26 calls resulting in the dispatch of emergency transport. A total of 24 callers attended the emergency department.

Most callers (174) did as advised. Forty six callers chose not to attend the recommended service and five presented to a medical service other than the one advised, four attending the emergency department when told to contact a GP and one seeing a GP when told to attend the emergency department. Only three callers presented to medical services after being advised that this was unnecessary. No evidence suggested that serious conditions were missed, and most of the emergency department attendances seemed appropriate.

Our audit shows that NHS 111 provided a safe, timely service and was particularly used by young people with minor illness. Patients generally followed the given advice, with only a few seeking further services against advice. Most calls were directed towards GP led services, and only 11% ended up in the emergency department (usually appropriately).

We conclude that NHS 111 may prevent large numbers of “worried well” attendances at out-of-hours services rather than simply creating another opportunity for people to be unwell.


Cite this as: BMJ 2014;349:g5034



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