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 over 3,400 staff and is said to answer around five million calls each year.

NHS Direct in England and Wales can be contacted by phone on 0845 46 47. For Scotland, NHS 24 provides a similar service and is available on 08454 24 24 24.

There is also a website which provides healthcare advice, directory and medical dictionary services. In addition NHS Direct Interactive is available to over 18 million households with either Sky Digital TV or Freeview.

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 expanded upon 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.

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 said to be high - monthly surveys routinely record rates of around 97 per cent. 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, and the service has yet to suffer any heavily publicised errors.

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.

Statistics

In 2009/10 NHS Direct: -
Received approximately 128,000 non-emergency calls transferred from ambulance services across England for further clinical assessment.
Provided over 70 locally commissioned services for NHS organisations, including providing GP and dental out-of-hours telephone assessment services.
Saved 2.4 million unnecessary appointments with GPs and other primary care services and saved 1.2 million unnecessary ambulance journeys and visits to accident and emergency departments.

As part of the national response to the swine flu pandemic, NHS Direct delivered the specially commissioned National Pandemic Flu Service (NPFS).
2.7 million people used the NPFS to gain advice through the web and over the telephone without needing to leave home. Of these, 1.8 million patients obtained authorisation for access to antiviral treatment without the need to visit their GP.

On World Mental Health Day (10 October 2009), NHS Direct launched a new online health and symptom checker to provide help and advice for people concerned about their mental health.
So far over 220,000 people have used the service.

Source: NHS Direct Annual Review - 2010

Quotes

"We're here to work with other NHS and social care organisations to make a difference to the lives of people in England 24 hours a day, 365 days a year. We're here for anyone who has health worries, and we have the knowledge and experience to give them real help and reassurance.
"Our vision is to provide remotely delivered care that is increasingly valued by patients and the wider health and social care system."

NHS Direct - 2010