NHS 111
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111 is a free-to-call
single non-emergency number A harmonised service of social value is a type of freephone service available in the European Union and in some non-EU countries (including the countries in the European Economic Area and United Kingdom), which answers a specific social need, ...
medical
helpline A helpline, or switchboard, is a telephone service which offers help to those who call. Many helpline services now offer more than telephone support - offering access to information, advice or customer service via telephone, email, web or SMS. ...
operating in England, Scotland and parts of Wales. The 111 phone service has replaced the various non-geographic 0845 rate numbers and is part of each country's
National Health Service The National Health Service (NHS) is the umbrella term for the publicly funded healthcare systems of the United Kingdom (UK). Since 1948, they have been funded out of general taxation. There are three systems which are referred to using the " ...
: in England the service is known as NHS 111; in Scotland, NHS 24; and in Wales, NHS 111 Wales. The transition from NHS Direct (0845 4647) to NHS 111 in England was completed during February 2014 with NHS 24 Scotland (08454 24 24 24) following during April 2014.
NHS Direct Wales NHS Direct Wales is a 24-hour telephone and internet health advice service provided by NHS Wales to enable people to obtain advice when use of the national emergency telephone number (999 or 112) does not seem to be appropriate but there is some de ...
started a phased roll-out of a similar 111 service in late 2016 and completed it in March 2022. As of June 2018, the 111 number was not in use across Northern Ireland. The NHS 111 service was extended to Northern Ireland from February 2020, although this is for advice relating to the
COVID-19 Coronavirus disease 2019 (COVID-19) is a contagious disease caused by a virus, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The first known case was COVID-19 pandemic in Hubei, identified in Wuhan, China, in December ...
virus only. After dialling, callers will be asked to follow prompts to determine what nation they are calling from. The service is available 24 hours a day, every day of the year and is intended for 'urgent but not life-threatening' health issues and complements the long-established 999 emergency telephone number for more serious matters, although 111 operators in England are able to dispatch ambulances when appropriate using the
NHS Pathways NHS Pathways is a triage software utilised by the National Health Service of England to triage public telephone calls for medical care and emergency medical services – such as 999 or 111 calls – in some NHS trusts and five of the ambulance se ...
triage system. NHS Direct Wales continues to operate via 0845 4647, but began a transition to 111 during late 2016. Initially available in Swansea, Bridgend and Carmarthenshire, the service is due for a country-wide roll-out by 2021.


Origins and development

During 2007, the
Department of Health A health department or health ministry is a part of government which focuses on issues related to the general health of the citizenry. Subnational entities, such as states, counties and cities, often also operate a health department of their ow ...
's ''Our NHS, Our Future'' report identified confusion surrounding access to certain NHS services in England and suggested the introduction of a national, three-digit number for out-of-hours healthcare services could help simplify the situation. Arrangements to identify and secure a suitable non-emergency number for England began in July 2009, with the number 111 allocated by telecommunications regulator
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in December of that year. In late August 2010, the Conservative-Liberal Democrat coalition government proposed that 111 would replace the existing
NHS Direct NHS Direct was the health advice and information service provided by the National Health Service (NHS), established in March 1998. The nurse-led telephone information service provided residents and visitors in England with healthcare advice 24 ho ...
(084546 47) telephone helpline in England. This suggestion proved controversial as some critics feared that NHS 111 would be a "cut-price" replacement for NHS Direct, because NHS 111 would be staffed mainly by telephone advisors whereas NHS Direct had been staffed by nurses. Health Secretary
Andrew Lansley Andrew David Lansley, Baron Lansley, (born 11 December 1956) is a British Conservative Party (UK), Conservative politician who previously served as Secretary of State for Health and Social Care, Secretary of State for Health and Leader of the H ...
said that the only major change would be the phone number, and that the service would be provided by existing staff. In July 2015 NHS England decided that what was required was an integrated urgent care access, treatment and clinical advice service which would operate over a large area.
Clinical Commissioning Group Clinical commissioning groups (CCGs) were NHS organisations set up by the Health and Social Care Act 2012 to organise the delivery of NHS services in each of their local areas in England. On 1 July 2022 they were abolished and replaced by Integra ...
s were told to stop any procurement exercises until revised commissioning standards and supporting procurement advice for integrated services were produced. These service specifications for England were published in 2017. In June 2020 it was announced that there were plans to integrate
LIVI Livi is a digital healthcare service by Kry International AB, a Swedish online healthcare company based in Stockholm. Kry International was established in 2015 and operates as Kry in Germany, Norway and Sweden. In France and United Kingdom, the Un ...
software into the service in three regions of the UK.


111 First

The 111 First system, which allows patients not in medical emergencies to call 111 to “book” urgent care, was launched in 2020, as a response to the impact of COVID-19 pandemic in England on emergency services. In July 2021 Healthwatch England found that it had potential to be a useful service, but the public “don’t really know what it’s for”. They said the messaging from the NHS ‘has not been strong enough’. Only 3% of English A&E attendances in June 2021 were “booked” in advance via NHS 111. The figure was similar in February 2022. According to Healthwatch England people “really welcome” the opportunity to book emergency appointments via 111, provided they know about it.


Management of the service

In England, the service is accountable at a Clinical Commissioning Group level but was originally commissioned on a regional basis, with a number of service providers.
NHS Direct NHS Direct was the health advice and information service provided by the National Health Service (NHS), established in March 1998. The nurse-led telephone information service provided residents and visitors in England with healthcare advice 24 ho ...
staff provided some of the 111 service during the original launch of the number, with other providers including regional ambulance trusts, and out-of-hours GP providers. The lack of clarity as to accountability was criticised in a
Deloitte Deloitte Touche Tohmatsu Limited (), commonly referred to as Deloitte, is an international professional services network headquartered in London, England. Deloitte is the largest professional services network by revenue and number of profession ...
report into the service launch failure by NHS Direct. As of December 2013 all NHS Direct contracts are being serviced by "stability partner" organisations such as ambulance trusts or GP co-operative organisations. The service operates 24 hours a day. When GP surgeries are closed normally between 6.30pm and 8am, at weekends and at Bank Holidays the service will refer many patients to an
out-of-hours service Out-of-hours services are the arrangements to provide access to healthcare at times when General Practitioner surgeries are closed; in the United Kingdom this is normally between 6.30pm and 8am, at weekends, at Bank Holidays and sometimes if the ...
. This can also happen if practices are closed for training purposes. The service uses a
clinical decision support system A clinical decision support system (CDSS) is a health information technology, provides clinicians, staff, patients, or other individuals with knowledge and person-specific information, to help health and health care. CDSS encompasses a variety of ...
which structures the response to a call, which may range from telephone advice to the dispatch of an emergency ambulance. Calls are initially assessed by a call handler and may be passed to a clinician. The service has been criticised for being too cautious and directing too many patients to A&E departments. GPs have complained that the service has not been inspected by the
Care Quality Commission The Care Quality Commission (CQC) is an executive non-departmental public body of the Department of Health and Social Care of the United Kingdom. It was established in 2009 to regulate and inspect health and social care services in England. I ...
and that it may jeopardise the safety of
out-of-hours service Out-of-hours services are the arrangements to provide access to healthcare at times when General Practitioner surgeries are closed; in the United Kingdom this is normally between 6.30pm and 8am, at weekends, at Bank Holidays and sometimes if the ...
s. Between 2010 and 2015 the service has handled 24 million calls with an average call length of 14 minutes. Although 111 is a helpline for non-emergency cases, 10% of calls trigger the dispatch of an ambulance - 93,000 in the 12 months from April 2014 to April 2015. A 2017 article in the ''
British Medical Journal ''The BMJ'' is a weekly peer-reviewed medical trade journal, published by the trade union the British Medical Association (BMA). ''The BMJ'' has editorial freedom from the BMA. It is one of the world's oldest general medical journals. Origi ...
'' that studied the performance of the 111 service concluded that patients were "largely satisfied" with the service, while "its success against some key criteria has not been comprehensively proven." Of calls answered by NHS 111 in March 2021, 78.2% were answered within 60 seconds. In March 2020 the figure was 30.2%. In January 2020 the Association of Ambulance Chief Executives called for a more joined up approach to the commissioning of 111, urgent care and ambulance services. The lead commissioner for 999 services is generally different, as those services operate over a wider area. The associations wants single regional specifications for integrated 999 and 111 provision, with no new tendering of 111 contracts which end this financial year. They want contracts for at least 5 year terms.
West Midlands Ambulance Service The West Midlands Ambulance Service University NHS Foundation Trust (WMAS) is responsible for providing NHS ambulance services within the West Midlands region of England. It is one of ten ambulance trusts providing England with emergency medi ...
took on the service across most of the West Midlands in 2019 but withdrew from the contract in 2022.
NHS England NHS England, officially the NHS Commissioning Board, is an executive non-departmental public body of the Department of Health and Social Care. It oversees the budget, planning, delivery and day-to-day operation of the commissioning side of the ...
is moving to larger geographical areas, advocating single virtual contact centres, allowing for calls to be answered quicker by utilising spare capacity across the country.


Launch and initial service failures

The first NHS 111 trial, in County Durham and Darlington, started on 23 August 2010. Nottingham, Lincolnshire and Luton began trialling the service later that year. NHS 111 was launched in a limited number of regions in March 2013 ahead of a planned national launch in April 2013. The
British Medical Association The British Medical Association (BMA) is a registered trade union for doctors in the United Kingdom. The association does not regulate or certify doctors, a responsibility which lies with the General Medical Council. The association's headquar ...
wrote to the
Secretary of State for Health The secretary of state for health and social care, also referred to as the health secretary, is a secretary of state in the Government of the United Kingdom, responsible for the work of the Department of Health and Social Care. The incumbent ...
to request that the launch be postponed. Its chair, Dr
Laurence Buckman Laurence Buckman (born 19 March 1954) is a British physician, medical doctor who works as a general practitioner (GP). Buckman was chairman of the British Medical Association's General Practitioners' Committee between 2007 and 2013. He was educat ...
, warned that the service as "a disaster in the making", and recommended delaying the full launch for safety reasons. The public sector trade union
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also recommended delaying the full launch. The initial launch was widely reported to be a failure. On its introduction, the service was unable to cope with demand; technical failures and inadequate staffing levels led to severe delays in response (up to 5 hours), resulting in high levels of use of alternative services such as
ambulances An ambulance is a medically equipped vehicle which transports patients to treatment facilities, such as hospitals. Typically, out-of-hospital medical care is provided to the patient during the transport. Ambulances are used to respond to medi ...
and
emergency departments An emergency department (ED), also known as an accident and emergency department (A&E), emergency room (ER), emergency ward (EW) or casualty department, is a medical treatment facility specializing in emergency medicine, the acute care of pati ...
. The problems led to the launch being delayed in
South West England South West England, or the South West of England, is one of nine official regions of England. It consists of the counties of Bristol, Cornwall (including the Isles of Scilly), Dorset, Devon, Gloucestershire, Somerset and Wiltshire. Cities and ...
,
London London is the capital and largest city of England and the United Kingdom, with a population of just under 9 million. It stands on the River Thames in south-east England at the head of a estuary down to the North Sea, and has been a majo ...
and
The Midlands The Midlands (also referred to as Central England) are a part of England that broadly correspond to the Kingdom of Mercia of the Early Middle Ages, bordered by Wales, Northern England and Southern England. The Midlands were important in the Ind ...
and the service was suspended one month after its launch in Worcestershire. The NHS 111 service was gradually launched in England over the course of 2013, with the rollout being completed in February 2014. It was announced in October 2013 that NHS Direct would be closed down in 2014. The 111 number was launched in Scotland in April 2014.


Coverage

The 111 number for NHS services is currently available in all of England, Wales and Scotland. As of early 2020, the NHS 111 service is available in Northern Ireland for advice relating to the COVID-19 outbreak. NHS 111 online is a
triage In medicine, triage () is a practice invoked when acute care cannot be provided for lack of resources. The process rations care towards those who are most in need of immediate care, and who benefit most from it. More generally it refers to prio ...
system also available for members of the public aged 5 or over in England, owned by the Department for Health and Social Care, commissioned by NHSX and developed and delivered by NHS Digital. It used the NHS Pathways series of
algorithm In mathematics and computer science, an algorithm () is a finite sequence of rigorous instructions, typically used to solve a class of specific Computational problem, problems or to perform a computation. Algorithms are used as specificat ...
s.


Coronavirus

A separate number NHS 119 is used for information and services relating to
COVID-19 Coronavirus disease 2019 (COVID-19) is a contagious disease caused by a virus, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The first known case was COVID-19 pandemic in Hubei, identified in Wuhan, China, in December ...
as of 18 May 2020. This number operates in England, Wales, and Northern Ireland, with lines being open from 07:00 to 23:00 hours. It allows people to book
NHS The National Health Service (NHS) is the umbrella term for the publicly funded healthcare systems of the United Kingdom (UK). Since 1948, they have been funded out of general taxation. There are three systems which are referred to using the " ...
drive through tests, order home testing kits, and apply for tests in a care facility. In Scotland, 0300 303 2713 is the non-geographical telephone number instead of 119.


European number

Within EU member states and territories a similar type of service is available via the harmonised European number for medical advice
116 117 A harmonised service of social value is a type of freephone service available in the European Union and in some non-EU countries (including the countries in the European Economic Area and United Kingdom), which answers a specific social need, in ...
as one of a number of ' Harmonised Services of Social Value'. The number 116 117 was never implemented by the UK and the UK has now left the EU.


Cyber attack

On 4 August 2022 at 07:00, Adastra, the computer system used by 85% of NHS 111 services was removed from service after a ransomware attack. , the service has not been restored with some question as to whether patient data had been exfiltrated. On 23 August 2022, London Ambulance Service was reported to be the first service to return to use of Adastra after the cyber-attack, with no clarification of patient data leakage during the incident.


References


External links

* {{Telephone numbers in the United Kingdom 2013 establishments in England Crisis hotlines National Health Service Telephone numbers in the United Kingdom Three-digit telephone numbers Emergency medical services in the United Kingdom