The National Health Service (NHS) 111 helpline was set up to improve access to urgent care in England, efficiency and cost-effectiveness of first-contact health services. Following trusted, authoritative advice is crucial for improved clinical outcomes. In paper published in the journal PLOS ONE, we examined patient and call-related characteristics associated with compliance with advice given in NHS 111 calls.
The importance of health interactions that are not face-to-face has recently been highlighted by COVID-19 pandemic. In this retrospective cohort study, NHS 111 call records were linked to urgent and emergency care services data. We analysed data of 3,864,362 calls made between October 2013 and September 2017 relating to 1,964,726 callers across London. A multiple logistic regression was used to investigate associations between compliance with advice given and patient and call characteristics.
Caller’s action is ‘compliant with advice given if first subsequent service interaction following contact with NHS 111 is consistent with advice given. We found that most calls were made by women (58%), adults aged 30–59 years (33%) and people in the white ethnic category (36%). The most common advice was for caller to contact their General Practitioner (GP) or other local services (18.2%) with varying times scales. Overall, callers followed advice given in 49% of calls.
Compliance with triage advice was more likely in calls for children aged <16 years, women, those from Asian/Asian British ethnicity, and calls made out of hours. The highest compliance was among callers advised to self-care without the need to contact any other healthcare service.
This is one of the largest studies to describe pathway adherence following telephone advice and associated clinical and demographic features. These results could inform attempts to improve caller compliance with advice given by NHS 111, and as the NHS moves to more hybrid way of working, the lessons from this study are key to the development of remote healthcare services going forward.
The demand for urgent care is increasing, and the pressure on emergency departments is of significant concern. General practitioner (GP)-led urgent care centres are a new model of care developed to divert patients to more appropriate primary care environments. In a study published in the Emergency Medicine Journal, I along with colleagues from Imperial College London explored why patients with minor illnesses choose to attend an urban urgent care centre.
We used a self-completed questionnaire among patients aged 18 years or over (N=649) who were triaged with a ‘minor illness’ on arrival at an urgent care centre co-located with an emergency department in London. The median age of participants was 29 years. 58% (649/1112) of patients attending the centre with minor illness during the study period took part. 72% of participants were registered with a GP; more women (59%) attended than men; and the majority of participants rated themselves as healthy (81%). Access to care (58%) was a key reason for using the service as was expectation of receiving prescription medication (69%). GP dissatisfaction influenced 10% of participants in their decision to attend. 68% did not contact their GP in the previous 24 hours before attending.
We concluded that the GP-led urgent care centre was attracting healthy young adults, who were mostly registered with a GP and used services because of convenience and ease of access rather than satisfaction levels with their GP. An expansion of primary care capacity for patients with acute minor illnesses could reduce the number of patient who see their own practice rather than attend an urgent care centre.
Urgent care centres (UCCs) were developed with the aim of reducing inappropriate emergency department (ED) attendances in England. We aimed to examine the presenting complaint and outcomes of care for young children attending two general practitioner (GP)-led UCCs in West London with extended opening times. The findings were published in BMJ Open.
Only 3% of all attendances to the GP-led UCCs were among preschool children over a 3-year period, with nearly a quarter of them being repeat attenders. Although the large majority of children attending were registered with a GP, over two-thirds attended out of hours. The most common reason for attending the GP-led UCC was for a respiratory disease, mainly an upper respiratory tract infection. The most commonly prescribed medications were for infections. Only one in five preschool children who attended required a referral to a paediatrician or an emergency doctor.
Two-thirds of preschool children attending GP-led UCCs do so out of hours, despite the majority being registered with a GP. The case mix is comparable with those presenting to an ED setting, with the majority managed exclusively by the GPs in the UCC before discharge home. Further work is required to understand the benefits of a GP-led urgent system in influencing future use of services especially emergency care.