Impact of NHS 111 Online on the NHS 111 telephone service and urgent care system: a mixed-methods study

Abstract

Background The NHS emergency and urgent care system is under pressure as demand for services increases each year. NHS 111 is a telephone triage service designed to provide advice and signposting to appropriate services for people with urgent health-care problems. A new service, NHS 111 Online, has been introduced across England as a digital alternative that can be accessed using a website or a smartphone application. The effects and usefulness of this service are unknown. Objectives To explore the impact of NHS 111 Online on the related telephone service and urgent care system activity and the experiences of people who use those services. Design and methods A mixed-methods design of five related work packages comprising an evidence review; a quantitative before-and-after time series analysis of changes in call activity (18/38 sites); a descriptive comparison of telephone and online services with qualitative survey (telephone, n = 795; online, n = 3728) and interview (32 participants) studies of service users; a qualitative interview study (16 participants) of staff; and a cost–consequences analysis. Results The online service had little impact on the number of triaged calls to the NHS 111 telephone service. For every 1000 online contacts, triaged telephone calls increased by 1.3% (1.013, 95% confidence interval 0.996 to 1.029; p = 0.127). Recommendations to attend emergency and urgent care services increased between 6.7% and 4.2%. NHS 111 Online users were less satisfied than users of the telephone service (50% vs. 71%; p < 0.001), and less likely to recommend to others (57% vs. 69%; p < 0.001) and to report full compliance with the advice given (67.5% vs. 88%; p < 0.001). Online users were less likely to report contacting emergency services and more likely to report not making any contact with a health service (31% vs. 16%; p < 0.001) within 7 days of contact. Thirty-five per cent of online users reported that they did not want to use the telephone service, whereas others preferred its convenience and speed. NHS 111 telephone staff reported no discernible increase or decrease in their workload during the first year of operation of NHS 111 Online. If online and telephone services operate in parallel, then the annual costs will be higher unless ≥ 38% of telephone contacts move to online contacts. Conclusions There is some evidence that the new service has the potential to create new demand. The service has expanded significantly, so it is important to find ways of promoting the right balance in numbers of people who use the online service instead of the telephone service if it is to be effective. There is a clear need and preference by some people for an online service. Better information about when to use this service and improvements to questioning may encourage more uptake. Limitations The lack of control arm means that impact could have been an effect of other factors. This work took place during the early implementation phase, so findings may change as the service expands. Future work Further development of the online triage process to make it more ‘user friendly’ and to enable users to trust the advice given online could improve use and increase satisfaction. Better understanding of the characteristics of the telephone and online populations could help identify who is most likely to benefit and could improve information about when to use the service. Trial registration Current Controlled Trials ISRCTN51801112. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 21. See the NIHR Journals Library website for further project information.

To what extent do callers follow the advice given by a non-emergency medical helpline (NHS 111): A retrospective cohort study

“…Early evaluations of the NHS 111 revealed low awareness of the service [ 14 ], and no improvement in perceptions of urgent care or the health service [ 15 ]. In following years, the usage of NHS 111 has significantly increased [ 16 ].…”

Will online NHS 111 reduce demand for the telephone NHS 111 service? Mixed methods study of user and staff views

“…The survey results have been published elsewhere (11) but have been summarised in table 1 below, to add context and explanation to the converged findings that are presented in this paper. We identified four key themes from our triangulated data analysis that helped to identify how people used the different services, and the potential for channel shift.…”

“…Although the response rate was low, it is similar to other surveys reported to the National NHS 111 minimum dataset. The characteristics of respondents was representative of the NHS111 telephone and online users in terms of gender of respondents, although younger people (under 35) were under-represented in our sample (11).…”

“…(9) The process and outcomes of the OL111 service may lead to different user experience, with evidence suggesting other algorithm-based triage systems to be more risk-averse than those involving healthcare professionals. (9,10) As part of a wider evaluation of the impact of the introduction of online NHS 111 on the NHS 111 telephone service (11), we explored user and staff perspectives to understand awareness and acceptability of the online service, how the service is used and whether there is potential for channel shift from Tel111 to OL111. Within this paper we explore perspectives of how and why people use the two services differently in order to understand the potential for channel shift from a telephone to an online service.…”

Measuring the impact introducing NHS 111 online had on the NHS 111 telephone service and the wider NHS urgent care system: an observational study

“…This work is part of a larger mixed-methods study ‘Impact of NHS 111 online on the NHS 111 telephone service and urgent care system: a mixed-methods study’ which is published in the NIHR Health Services and Delivery Research journal. 7 The larger study used both quantitative and qualitative methods to explore what impact introducing NHS 111 online had on the NHS 111 telephone service and the urgent care system. This article presents in greater detail the quantitative methods and analysis.…”