Belfast Telegraph

Dialling 111 for non-emergency medical advice is a prescription for chaos: GPs

By Lisa Smyth

A controversial non-emergency telephone number designed to reduce the strain on the 999 healthcare service is to be introduced in Northern Ireland.

Doctor’ leaders have expressed concerns over the planned implementation of the NHS 111 helpline across Northern Ireland as part of a major review of health and social services.

The chair of the British Medical Association’s GP committee in Northern Ireland said he is concerned it would lead to more people going to A&E and increase pressure on already overstretched paramedics.

Dr Tom Black said: “You would be speaking to someone who is a lay person, they would not be a doctor or a nurse.

“As a doctor, triaging a patient over the telephone is one of the most difficult things you can do as you can’t see the person and you can’t take their temperature, check their pulse or other vital signs.

“We have very grave concerns about the NHS 111 scheme. We believe it would lead to more A&E admissions and more call outs for ambulances.”

Plans to roll out the 111 number across England have already been delayed in the face of strong criticism from doctors there, but yesterday Health Minister Edwin Poots announced the scheme will be introduced in Northern Ireland.

The new number is intended as an alternative to the 999 number for people who require urgent medical help but whose lives are not at risk.

It is to be rolled out as part of a raft of measures to modernise and improve health and social care in Northern Ireland.

Other proposals in the Transforming Your Care review include:

  • More minor surgical procedures — such as mole removal — will be carried out in GP surgeries.
  • Outpatient appointments with consultants will increasingly happen in GP surgeries — which means that patients do not have to travel as far.
  • Patients with long-term chronic conditions, such as asthma, will monitor their conditions themselves at home and results will go directly to clinicians who will decide whether they need to come to hospital — this will cut the number of emergency admissions and hospital bed stays.
  • All long-stay learning disability and mental health institutions will be closed by 2015.
  • Greater use of direct payments so that patients and service users make decisions about the care they want as opposed to health trusts telling them what will happen.
  • Increase in the number of ward rounds at weekends so patients are discharged and during the week they will happen sooner so beds are freed up earlier in the day. It is hoped this will reduce the length of time other patients have to wait to be admitted to a ward, either from the community or A&E.

Mr Poots addressed Assembly Members yesterday to present an update on progress of the far-reaching Transforming Your Care review.

He released the draft population plans, developed by each health trust, which provide detail on how services will be delivered in the future.

However, Garrett Martin, deputy director of the Royal College of Nursing (RCN) in Northern Ireland, said he would like more details on how services, staff and patients will be affected by the proposed changes.

“We support the direction of Transforming Your Care but the devil is in the detail and that is lacking at the moment,” he said.

“We welcome consultation on this matter.

“If more care is going to be delivered in the community then you will need more nurses working in the community and that is going to take proper planning and training.”

Mr Garrett also said it is essential that facilities in the primary sector can cope with the increased demand in order that patients and staff do not suffer.

Key issues in the changing face of healthcare

Hospital services

More care will be delivered in the community. More minor surgical procedures and appointments with consultants will happen in GP surgeries. It is hoped this will cut waiting times for outpatient appointments. But more specialised care will be delivered in centres of excellence. The Northern Trust has said it would like to build a new acute hospital in a different location to Antrim and the Causeway — most likely in Ballymena — but said it would be at least 10 years and millions of pounds before this would happen.

Emergency medicine

Little has been done to dispel rumours over the future of the A&E at the Causeway Hospital in Coleraine. There is no immediate threat to its services. But it raises concerns over the long-term viability of some services, including emergency medicine, as a result of difficulties recruiting staff. Other A&Es are safe. It is proposing to increase the opening hours at Lagan Valley Hospital in Lisburn (pictured).

Chronic conditions

With more people living longer, an increasing number are being diagnosed with a range of medical conditions.

Transforming Your Care encourages people to take responsibility for health — the introduction of telemonitoring means patients can monitor conditions at home.

Clinicians have quick and easy access to the test results and can treat patients before a problem develops, cutting unnecessary appointments. This could reduce the number of people who turn up at A&Es and are admitted, saving the health service millions of pounds in the process.

Mental health and learning disabilities

People who depend on social services will be given more say over their care. It recommends more people receive direct payments so they can decide what services they want to help them live in the community.

It has also called for all long-term institutions for people with mental health and learning disabilities to close by 2015.

Six admissions units will be developed in Northern Ireland.

Older people and palliative care

The elderly population is expected to grow considerably. Transforming Your Care wants to support older people to live independently in their own homes. Reablement services are to be provided where someone recovering from illness gets the support to allow them to return home. There will be increased access to specialist palliative care support at home.

Budget

The population plans all say additional money is required to make them happen. They have identified a series of cash-saving schemes. Health bosses have said £4m will be made available this financial year with more in subsequent years, but health professionals remain sceptical as to whether the necessary funding will materialise.

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