Calls to 111 are initially dealt with by non-clinical staff.

Mostly true. 111 Health Advisors, a.k.a. call handlers, are largely non-clinical (although there is the occasional clinician in training). They undergo 2 weeks of classroom work which gives them a grounding in identifying more common life-threatening signs and symptoms, but are strictly required to stay within the framework of questions as set out by the Pathways algorithm. Further training is ongoing during their employment and their growing experience should not be discounted either.


Furthermore, the call centre is always staffed by a mix of health advisors and clinical advisors (nurses, paramedics, midwives and other allied healthcare professionals). They work closely together and any call which Pathways wants to send an ambulance response can be checked with a clinician. Once past the initial [module 0] questions - and even during these questions in some cases - any potential ambulance response is verified by a clinician. In many of these cases, the clinician will advise the health advisor to transfer the call to a clinical advisor for 'further probing'. Health advisors cannot deviate from the Pathways outcome (known as a 'disposition'), but clinical advisors can override this, and frequently do when an appropriate alternative is available.


Clinical staff do help out with calls when demand is high and on the one occasion I've taken a call from a paramedic who assumed I was a health advisor, I found him to be quite condescending and rude. He was so abrupt, he didn't give me an opportunity to explain my role or qualifications. Nonetheless, after he terminated the call I did my best to address his request for an immediate GP callback at the scene of a peri-arrest patient with a DNAR. Sadly he went on to make his decision without the GP's (or my) clinical input and I fear he might have made a different choice had he taken the time to engage with me rather than bark down the phone.


Respect costs nothing, even in difficult circumstances, whether you're talking to a health advisor or a clinician.

4. NHS 111 would be more effective if all calls were handled from the outset by clinicians.

There are a number of reasons why this would not necessarily be the case. Notwithstanding the challenges of telephone triage as mentioned in Point 1, the sheer scale of this proposal in the face of the current demand makes the idea impractical.

Last year (2015), nationwide 111 dealt with nearly 1.1 million calls every month. The majority of those calls are for minor ailments, non-urgent problems or other enquiries ('I can't get through to my doctor for an appointment', 'my child has a runny nose', 'can I take paracetamol and ibuprofen?', 'I need a repeat prescription' etc.). It would be a monumental waste of tax payers' money to have qualified healthcare professionals deal with these issues. It makes as much sense as insisting GPs man their own receptions.

Even if it was financially justifiable, the current challenges within the NHS means we hardly have an excess of healthcare professionals to make an all-clinician telephone triage service viable.

To put this line of thought into context by comparing the current climate with that of 111's predecessor NHS Direct, which did favour clinicians as an initial point-of-contact, here's some stats to compare.

    In 2006/7, NHS Direct's busiest day (23rd December) saw 25,000 calls. An average day in 2015 saw 35,000 calls dealt with by NHS 111.
    In 2006/7, NHS Direct answered 68% of all calls received within 60 seconds. In 2015, NHS 111 achieved 91.4%.
    In 2006/7, NHS Direct referred 32% of all cases to 'emergency and urgent' services. In 2015, NHS 111's figure was 19% (11% ambulance, 8% emergency treatment centre).