NHS Direct

What is NHS Direct?

NHS Direct is a nurse-led telephone information service, which provides basic healthcare advice to callers and directs those with more serious complaints to the appropriate part of the wider NHS. It is accessible 24 hours a day, seven days a week, and is one of the largest telemedicine services in the world.

The service was launched in 1998, as a means of extending public access to healthcare services, to relieve pressure on increasingly hard-pressed GPs and accident and emergency departments, and to iron out regional inequalities in service provision. It formed a key part of the Labour government's 'The New NHS' White Paper.

In April 2007 NHS Direct became an NHS Trust, giving it the opportunity to apply for foundation trust status.

NHS Direct employs around 2,750 staff and handles over 8 million calls a year.

NHS Direct in England can currently be contacted by phone on 0845 46 47, although this is gradually being changed to the new NHS 111 non-emergency number.

There is also a website which provides healthcare advice, directory and medical dictionary services. The website is reported to receive over 1.5 million visits every month. A free mobile app for Android and iPhone smartphones provides mobile access to a range of health and symptom checkers.

The Trust also has a network of 30 contact centres across England linked together through its electronic network to create a single 'virtual' national contact centre.
NHS Direct headquarters are at 120 Leman Street, London, E1 8EU.

Background

NHS Direct was first established in March 1998, as part of the New Labour government's plans to reform the Health Service. It was originally launched in three pilot areas: Newcastle, Preston and Milton Keynes. The concept of a complementary online service was introduced under the 1998 NHS Information Strategy, with the objective of providing a companion website for the telephone service by autumn 1999. The website was fully operational by December 1999.

In November 2000, NHS Direct was expanded to cover the whole of England, following the success of the pilots, which had been gradually extended throughout 1998 and 1999. NHS Direct Wales was launched in April 2001.

NHS Direct was originally organised on a local basis, with individual sites (there were 24 in England and Wales in 2002) and staff located within 'Host Trusts', which were mainly Ambulance Trusts.

In April 2004, NHS Direct in England was consolidated into a single national provider, a Special Health Authority. Local NHS bodies commission services directly from the SHA.

The change to NHS Trust in 2007 established NHS Direct as an integral part of NHS frontline services.

In August 2010, the Department of Health announced the launch of a new NHS non-emergency 111 number.  The NHS 111 service was piloted in four areas in 2010 prior to national roll-out.

In 2011/12, NHS Direct led on four NHS 111 pilots and made fundamental changes to its operation in preparation for the decommissioning of its national 0845 4647 helpline number and the transition to NHS 111, which is expected to be completed nationally by April 2013.

Controversies

At its launch, concerns were voiced that NHS Direct was designed to keep patients away from overburdened doctors' surgeries and emergency departments, offering them a 'call centre' service instead. The qualification of nurses to give medical advice was also questioned in some quarters.

Much of this criticism stemmed from the Government appearing not to take into consideration some of the concerns raised by stakeholders during the extensive consultations that preceded implementation.

However, public satisfaction with the service is reported to be high.  Moreover, NHS Direct claims that between two and three per cent of its callers are unaware of the severity of their symptoms and are immediately referred to emergency services. Critics of the clinical service provided have suggested that diagnoses err on the side of caution.

Within the NHS and the Treasury, there was concern about the effect of the development of NHS Direct on human resources. The absence of an HR strategy was seen to threaten nurse recruitment and retention in the vicinity of NHS Direct sites.

The announcement that the NHS Direct 0845 number was to be replaced with the NHS 111 service led to concerns that the Government intended to scrap NHS Direct altogether and a campaign to 'Save NHS Direct' was launched.

Health Secretary Andrew Lansley insisted that NHS Direct was not to be shut down and he defended the change to the new number saying firstly it would be easier for people to have just two NHS numbers to remember – 999 for emergencies, 111 for non- emergencies; secondly the 111 number would free of charge.  He also claimed that the Government's plans would "build on NHS Direct's work still further."

Nevertheless many in the Labour party remained sceptical that the quality and provision of service would be retained and Lord Prescott, who launched the 'Save NHS Direct' online petition said the campaign would continue until a commitment to this effect was received from the Government.

Statistics

These facts and figures are correct as of 31 August 2012.


0845 service specific data:

The top reasons for calling are abdominal pain, dental tooth/jaw pain, rashes, chest pain and ingestion of a toxic substance.

The top reasons for using the online health and symptom checkers are abdominal pain, female sexual health issues, rashes & skin problems, head and neck pain and diarrhoea and vomiting.

Around 55% of calls are from women.
Around 90% of calls are from people with symptoms.
Around 10% of calls are requests for health information.

The value of NHS Direct to the NHS:

In 2011/12, 0.7m A&E attendances/999 calls, 1.5m GP consultations and 0.6m other face-to-face appointments were avoided through patients' use of NHS Direct's phone and web core services.

Telephone:

50% of calls to 0845 4647 are completed within NHS Direct, where callers are given advice that allows them to care for themselves at home, only seeking further advice if symptoms persist.
Only 30% of calls to 0845 4647 need urgent or emergency referral (including A&E, 999 and GP urgent).
Of the patients given self care advice, 24% would have gone to A&E and 31% would have gone to see their GP if NHS Direct had not been available.

Web:

Of the web users receiving self care advice, 33% would have gone to see their GP, and 4% would have gone to A&E if NHS Direct had not been available.

NHS Direct has 31 sites across the country; 30 of these are contact centres linked into a single virtual contact centre.
NHS Direct has the capacity for over 170 nurses to work from home either permanently or for short periods when the service is busy.

NHS Direct constantly receives many more expressions of thanks than complaints and its complaints rate is currently less than one in every 10,000 calls. For every one complaint, it gets 2.5 compliments.

NHS Direct has unrestricted registration with the Care Quality Commission (CQC).

Following a routine unannounced inspection in January 2012, the Trust achived NHS Direct User Satisfaction Monitoring for 0845 (core) service – June 2012 (IFF Research).

91% of callers surveyed were satisfied with the way NHS Direct handled the whole process, highlighting the quality of the advice given, the reassurance it provided and the speed and the politeness of staff as the top reasons for satisfaction.
92% of callers followed the advice NHS Direct gave them.
78% of callers would ‘most definitely’ recommend the service again.

NHS Direct’s Net Promoter Score (NPS) was 78, which is considered excellent.The NPS is a measure of advocacy for a service or brand, as measured from users rating the service on a scale of 1-10. 

NHS Direct has been awarded the Information Standard quality mark as a provider of high quality health and social care information.

Source: NHS Direct - 2012
 

Quotes

"Our values reflect the best of who we are and what we want to be."

"We want our values to influence our behaviours, both internally and externally. They underpin the delivery of our objectives and the achievement of our vision:

"We’re here
"We deliver
"We care
"We empower
"We think ahead
"We listen."

NHS Direct 'Values'

"During a year in which the NHS has been focused on internal organisational change, patients and the public have continued to demonstrate increasing enthusiasm for remote and virtual care, with the NHS Direct National Health Service Trust leading the way in providing useful and valued digital services."

Joanne Shaw, chair NHS Direct National Health Service Trust  -2012

 

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