Is NHS 111 First making a difference?
From 1 December 2020, the NHS has introduced a new system called NHS 111 First.
This means that NHS 111 can now book you an appointment at your local A&E or get you an urgent appointment at an alternative health service. The NHS 111 First campaign encourages people to call NHS 111 before going to emergency departments.
More information about NHS 111 First
To better understand public attitudes towards NHS 111, including awareness of the new services offered by NHS 111 First, and support the best possible roll-out of this new service, we commissioned YouGov to run a UK representative online poll of 2076 adults (18+) between 27th – 28th Jan 2021.
Through the Healthwatch network, we also gathered views from over 400 people who had used NHS 111 in the last six months.
What’s working
The public has a good awareness of NHS 111 and are likely to use it
Most people know they can call NHS 111 for help and information.
The majority (84%) of polling respondents said that they were aware that they could call NHS 111 for urgent medical advice. Almost three-quarters (70%) agreed that they were more likely to call NHS 111 than go straight to an emergency department when they had an urgent medical problem.
Nearly half of polling respondents had previously called NHS 111 (46%). When asked to think about the most recent time they had called NHS 111, the most common reasons for the call were because people wanted advice or reassurance (55%), didn’t think it was a 999 emergency (40%), or did not know whether they needed to go to A&E or another NHS service (31%).
Getting the right help
More than three out of four people who had used the service and got through to an advisor (79%) felt they had got the help they needed.
Usually this meant that they had their question answered directly (41%), received a call back from a medical professional (49%), or were told to go straight to A&E (24%).
The groups most likely to say they had a very good experience of the service were those who had their questions answered directly and those who had a time-slot booked at the emergency department.
This suggests that people have the best experience of NHS 111 when the call handler is able to confidently and quickly advise them on their health issue, and that people appreciate the new appointment booking service. However, the number of people who told us they received an appointment at A&E or GPs was small, indicating that roll-out of the new service is still in its early stages (11% and 7% respectively).
Satisfaction with NHS 111
Almost three quarters (72%) of those that have used the service agreed that they generally had positive experiences when they called NHS 111, while 12% disagreed and 13% were neutral.
When asked what could have made their experience of NHS 111 better, 19% stated their experience would have been improved if they had waited less time for their call to be answered or to be called back; 14% felt they could have been directed to a service that better met their needs; 11% of people that the advice given could have been more helpful.
What could be improved
Confidence in call handlers
Not feeling confident in the advice given by NHS 111 call handlers was a common issue. Only 55% of all polling respondents said they felt confident that when they phoned the service, the person they spoke to would be qualified to help them.
Through the Healthwatch Survey, many people also told us they were frustrated at having to answer long lists of questions, often multiple times, and said they felt they were not being listened to, especially when they already knew their own health condition well.
This supports what people have shared with us in our own survey on accessing urgent and emergency care, with people often saying that their experience of NHS 111 could have been improved if they felt call handlers were better equipped to answer their queries.
After an extremely long conversation where I had to give so much information, I then had to go through the whole conversation again when passed on. Frustrating, upsetting and a waste of time.”
In several comments, people told us how their frustration was reduced when the reasoning behind asking a series of questions to exclude certain urgent conditions was explained to the caller. This emphasises the importance of clear and personable communication by call handlers.
Awareness of new NHS 111 First service is low
Those who did use NHS 111 First and had a time slot booked for them at A&E were highly likely to rate their experience as very good, suggesting that that the new system is working when people are given the option.
However, awareness of the new service is low. 80% of our polling respondents were not aware that NHS 111 could reserve time slots at GPs and 73% were not aware they could reserve time slots at A&E.
This is important, as 60% of people who were previously unaware of the service told us that knowing this information made them more likely to call NHS 111 next time they had an urgent medical problem.
Those who had heard of the new appointment-booking services offered as part of NHS 111 First were most often told about it by friends and family (21%), through TV (18%) or by call handlers once they had already called 111 (14%). This shows that word of the new service is slowly spreading.
However, awareness of NHS 111 First based on media or publicity (including posters (7%), radio (8%), news stories (9%)) was low, suggesting that an improved media and communications strategy might encourage more people to use NHS 111 ‘first’ when seeking urgent medical care.
Service integration
Through the Healthwatch survey on urgent and emergency care, some people told us that NHS 111 did not give them the right information when directing them to other services.
"When I finally got through I was asked a lot of questions (all relevant). … The pain was very severe and I told them so. I was told by 111 that they would e-mail my doctor with all the details and the doctors would be in touch immediately. Waited a long as possible, maybe 20 minutes. No call, so I called my doctor. The doctor had not received an e-mail or knew anything about it. They suggested that I call 111 again. Started trying to do that, got asked all the same questions with the same responses. In the end [I] call 999, who came within minutes. … If I get to the point of needing help 111 will be missed out and 999 will be my go to service. Then I know I will get attended to sensibly and with knowledge."
Man, Rotherham, aged 65 - 79
This shows that in places NHS 111 is not properly linked into other services – such incidents will reduce people’s confidence in NHS 111 and may hamper efforts to encourage people to use NHS 111 as their first point of contact when accessing NHS services.
Inconsistent roll-out of the new appointment booking service has also created confusion for both staff in A&E and NHS 111 and in some cases resulted in bad experiences for patients.
My wife was told to go straight to A&E. But when she got there, she had to wait on her own for three hours as 111 did not make an appointment for her. My wife suffers from anxiety so having to sit around on her own in the small waiting room with people not wearing facemasks was very distressing.
Ensuring no one gets turned away
When the new NHS 111 First offer of time-slot bookings in A&E was piloted in autumn 2020, local Healthwatch in ‘early mover’ sites piloting the new system raised a number of questions with us. Their main concerns were that people arriving at emergency departments without having called NHS 111 first would be re-directed to contact 111 online, or that walk-ups would be discouraged, meaning that some could miss out on essential care.
Although NHS England have assured us that this will not happen, some respondents to our survey on accessing urgent and emergency care shared experiences of feeling shamed or discouraged when arriving without a pre-booked time slot.
"Urgent care nurse unhappy at us arriving without appointment or emergency and showed no compassion to my son's distress at the pain he was in. This was despite the centre being almost empty of patients."
Woman, aged 50 – 64
"I called 111 for advice …. I gave full details and thought they would be able to give guidance on the phone but they booked me an appointment at A&E. A&E were not interested & sent me home, saying nothing to worry about. They seemed surprised 111 had sent me."
Woman, Oxfordshire, aged 25 - 49
As the pandemic reshapes the way that people access care, with an ongoing shift to a system of digital appointments, triage and NHS 111 First encouraged by NHS leaders, it is essential that universal access to urgent and emergency care services is maintained, and that people don’t experience a worse service as a result.
Conclusions
NHS 111 is a well-known service, and the new option of pre-booked time slots at A&E and other urgent appointments is useful 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.
During the pandemic, a shift to remote access of services has happened extremely quickly and there is little evidence that people have been consulted about how they view these changes. As part of a system-wide effort to understand the impact of the pandemic on how people access care, the NHS should conduct a review of how people have accessed NHS services during the pandemic to ensure no one is experiencing a worse service.
Although we know that an additional £24 million is being invested in NHS 111, most of which will go to hiring more call handlers and improving the ratio of clinical to non-clinical staff dealing with calls, it is not clear whether this will be enough to increase people’s confidence in the service or cater for an increased demand as a result of both the pandemic and the roll out of NHS 111 First. Greater transparency on how additional investment is being used, alongside modelling of the predicted increase in demand, would help the sector scrutinise whether the investment is sufficient.
Reassuring people that they always have the right to be seen at A&E, but emphasising that contacting 111 first could mean that they can wait in the comfort of their own home and be seen more quickly when they arrive at A&E, should be part of a stepped-up communications strategy of promoting NHS 111. National expectations need to be set out for how emergency departments should effectively balance and manage both patients arriving via NHS 111 and patients arriving without a pre-booked time slot. This should include ensuring that the NHS 111 First offer is properly integrated with new urgent and emergency care access standards.
About where our data comes from
All figures, unless otherwise stated, are from YouGov Plc. Total sample size was 2076 adults. Fieldwork was undertaken between 27th - 28th January 2021. The survey was carried out online. The figures have been weighted and are representative of all UK adults (aged 18+).
Healthwatch England conducted an online survey of 789 adults (aged 18+) between 13 December 2020 and 26 January 2021.
How can NHS 111 help you?
Take a look at our advice and information article to find out how NHS 111 can help you get urgent medical advice and care.
