111 workload concerns highlighted by the BMJ

Article taken from the Mail Online...

'The NHS 111 helpline is piling pressure on health services, with the number of calls referred through to GPs and to A&E departments respectively increasing by almost 200%, according to healthcare leaders.
The claims come as the NHS has faced one of its toughest-ever winters, with figures showing that A&E departments across the country have missed their four-hour waiting time target for 15 weeks in a row.
Analysis by the British Medical Association (BMA) suggests that the number of calls referred through to GP services has increased by 186%, and to A&E by 192% - with some patients referred to GPs when they've reported symptoms of colds and sore thumbs.
Separate figures also suggest a sharp drop in the percentage of calls where patients had been given safe "self-care" advice over the phone rather than being referred to NHS services.
The analysis by the BMA of NHS England's latest statistics on NHS 111 found that the number of calls referred to GP services from the helpline rose by 186% when comparing January-October 2013 to January-October 2014 - from 2,844,452 to 8,138,863 - an increase of 5,294,411.
The number of calls referred to A&E services rose by 192% when comparing the same periods, from 374,506 to 1,092,967 - an increase of 718,461.
Figures from the Primary Care Foundation estimate that the number of calls designated as "self-care" - where patients can safely treat their condition after advice from a call hander - may have also declined from 48% in 2012 down to an average of 15% in 2013 and 2014.
Dr Charlotte Jones, BMA's GP lead on NHS 111, said the BMA has consistently highlighted serious concerns about NHS 111 and how it is "not delivering appropriate advice and outcomes" for patients who call the service.
She said before it was launched in March 2013 that the BMA's GP committee warned that it would struggle to cope with demand, a prediction she says "proved to be correct when large parts of the system collapsed immediately after they opened".
She said: "Although there have been some improvements in capacity since its disastrous early introduction, this analysis of referrals over the past two years demonstrate that there has been a huge increase in the number of people put through to key parts of the NHS such as A&E and general practice.
"There is no doubt that if a patient needs any form of medical care they should be referred through to an appropriate doctor or nurse, but there are serious doubts as to whether this huge increase in workload is clinically necessary.
"Anecdotally, GPs have reported to the BMA that patients have been referred to them with colds, sore thumbs or other conditions that could have been treated safely by sensible advice over the phone, advising a patient on how to self-care, such as picking up medication from a local pharmacist."
Dr Jones added: "There is little doubt that the NHS cannot afford to have unnecessary workload being created given the unprecedented pressure on our health service.
"GP practices are already struggling to deliver enough appointments to their patients as demand rises, resources fall and staff shortages continue to undermine GP services."
BMA chair of council Dr Mark Porter said a "fundamental problem" with NHS 111 is that it employs "non-clinically trained staff who follow a formulaic script rather than using clinical judgement to assess how calls are dealt with".
He said: "Understandably, this is likely to lead the call handlers, with limited experience of medicine, to be cautious and refer patients to the NHS when a trained professional could have encouraged them to effectively self-care.
"Key NHS services cannot afford to be taking on unnecessary work when they are struggling to treat the number of patients who do need genuine care."
Dr Porter said the government needs to do "a serious and urgent analysis" of the effect of NHS 111 on the "wider urgent and unscheduled care system" to determine where it may be working inefficiently and to ensure that it is cost effective.
"This should lead to recommendations on increasing the level of self-care and ensuring that we have a programme to increase the number of expertly-trained clinicians answering calls from patients," he said.