NHS 111 First - our position
From 1 December 2020, the NHS introduced a new system called NHS 111 First. NHS 111 can book people an appointment at urgent and emergency care services, including A&E. We have highlighted inconsistencies in how NHS 111 is linked with other services and called for a patient evaluation of how it is working.
Our evidence
- The public is aware of NHS 111 and is likely to use it, but awareness of the new pre-booking offer is low. Representative polling we conducted in January 2021 found that while most people know they can call NHS 111 for help and information, most were unaware NHS 111 could reserve time slots at GPs or A&E.
- There needs to be more consistency in how 111 First links up with other services. When NHS England introduced 111 First, we ran a pilot project with local Healthwatch to share real-time evidence on how the service was working. Local Healthwatch were concerned that people arriving at emergency departments without having called NHS 111 first would be re-directed to contact NHS 111 or that walk-ins would be discouraged, meaning that some people could miss out on essential care. Some people told us that NHS 111 did not give them the right information when directing them to other services.
- While many people get help via NHS 111, many don’t feel confident in the advice given by NHS 111. Only 55% of all polling respondents said they felt confident that when they phoned thee service, the person they spoke to would be qualified to help them. Our survey found that people often said that their experience of NHS 111 would be improved if they felt call handlers were better equipped to answer their queries.
What we're calling for:
- A patient evaluation of how NHS 111 First is working. The service was introduced during the pandemic, partly as an initiative to reduce overcrowding in A&E departments by enabling pre-booking of appointments. These changes were rolled out extremely quickly, with little public consultation. To ensure no one is experiencing a worse service or gets turned away from urgent care, the NHS should look back over how 111 has worked to date, to understand whether pre-booked appointments translate into shorter waiting times and better patient experience.
- Better communication with patients about the NHS 111 First service. NHS 111 is a well-known service, and the new option of pre-booked time slots at A&E and other urgent appointments is helpful to patients when it works well. But its full potential for improving patient experience can only be unlocked if more people are aware of the offer and if people consistently receive high-quality care and advice through NHS 111.
- Increase people’s confidence in NHS 111 First by upskilling call handlers. In 2021, an additional £24 million was invested in NHS 111, to hire more call handlers and improve the ratio of clinical to non-clinical staff on calls. But it is not clear whether this has done enough to increase people’s confidence in the service or cater for increased demand due to both the pandemic and the roll out of NHS 111 First. Greater transparency on how additional investment is being used, alongside an evaluation of the service to understand the increase in demand, would help the sector scrutinise whether the investment is sufficient.
Our work to date
What action we’ve taken:
Through our work on urgent and emergency care, we advocated for the NHS to explore pre-booked time slots for people to attend A&E, allowing them to wait in the comfort of their home.
We have shared real-time feedback from local Healthwatch to raise inconsistencies in how the 111 First service operates. This included concerns that, in some areas, 111 was ‘booking people in’ to appointments which did not exist when they arrived at the service, and concerns that people without pre-booked appointments would be turned away from A&E.
Outcomes:
Following the national roll-out of NHS 111 First, concerns raised by local Healthwatch led to clarifications from NHS England on how those with pre-booked time slots should be prioritised against A&E walk-ins, and that A&E will never turn people away. In 2021, an additional £24 million was invested in NHS 111 to improve call handling.
NHS England also promised to conduct a full patient evaluation of how the NHS 111 First programme is working. This evaluation has not yet taken place and we continue to challenge decision-makers to collect and share additional evidence on how the service is working.
In January 2023, NHS England updated the NHS standard contract to ensure that all A&E and urgent care services support pre-booking through 111. This should support a more consistent application of pre-booked attendance slots for A&E.
