Does deprivation affect the demand for NHS Direct? Observational study of routine data from Wales

Emergency department staff views of NHS 111 First: qualitative interview study in England

BACKGROUND

NHS 111 is a phone and online urgent care triage and assessment system that aims to reduce UK ED demand. In 2020, 111 First was introduced to triage patients before entry to the ED and to offer direct booking for patients needing ED or urgent care into same-day arrival time slots. 111 First continues to be used post pandemic, but concerns about patient safety, delays or inequities in accessing care have been voiced. This paper examines ED and urgent care centre (UCC) staff experiences of NHS 111 First.

METHOD

Semistructured telephone interviews were conducted with ED/UCC practitioners across England between October 2020 and July 2021 as part of a larger multimethod study examining the impact of NHS 111 online. We purposively recruited from areas with high need/demand likely to be using NHS 111 services. Interviews were transcribed verbatim and coded inductively by the primary researcher. We coded all items to capture experiences of 111 First within the full project coding tree and from this constructed two explanatory themes which were refined by the wider research team.

RESULTS

We recruited 27 participants (10 nurses, 9 doctors and 8 administrator/managers) working in ED/UCCs serving areas with high deprivation and mixed sociodemographic profiles. Participants reported local triage/streaming systems predating 111 First continued to operate so that, despite prebooked arrival slots at the ED, all attendances were funnelled into a single queue. This was described by participants as a source of frustration for staff and patients. Interviewees perceived remote algorithm-based assessments as less robust than in-person assessments which drew on more nuanced clinical expertise.

DISCUSSION

While remote preassessment of patients before they present at ED is attractive, existing triage and streaming systems based on acuity, and staff views about the superiority of clinical acumen, are likely to remain barriers to the effective use of 111 First as a demand management strategy.

Exploring variation in ambulance calls and conveyance rates for adults with diabetes mellitus who contact the Northern Ireland Ambulance Service: a retrospective database analysis

Background:

People with diabetes frequently contact the ambulance service about acute problems. Overall, treating diabetes and its associated complications costs the NHS 10% of the annual budget. Reducing unnecessary hospital admissions and ambulance attendances is a high priority policy for the NHS across the UK. This study aimed to determine the characteristics of emergency calls for people with diabetes who contact the ambulance service and are subsequently conveyed to hospital by the Northern Ireland Ambulance Service (NIAS).

Methods:

A retrospective dataset from the NIAS was obtained from the NIAS Trust’s Command and Control system relating to calls where the final complaint group was ‘Diabetes’ for the period 1 January 2017 to 23 November 2019.

Results:

Of a total 11,396 calls related to diabetes, 63.2% of callers to the NIAS were conveyed to hospital. Over half of the calls related to males, with 35.5% of callers aged 60–79. The more deprived areas had a higher frequency of calls and conveyance to hospital, with this decreasing as deprivation decreased. Calls were evenly distributed across the week, with the majority of calls originating outside of GP working hours, although callers were more likely to be conveyed to hospital during working hours. Calls from healthcare professionals were significantly more likely to be conveyed to hospital, despite accounting for the minority of calls.

Conclusion:

This research found that older males were more likely to contact the ambulance service but older females were more likely to be conveyed to hospital. The likelihood of conveyance increased if the call originated from an HCP or occurred during GP working hours. The availability of alternative care pathways has the potential to reduce conveyance to hospital, which has been particularly important during the COVID-19 pandemic. Integration of data is vitally important to produce high quality research and improve policy and practice in this area.