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

Abstract

National Health Service (NHS) 111 helpline was set up to improve access to urgent care in England, efficiency and cost-effectiveness of first-contact health services. Following trusted, authoritative advice is crucial for improved clinical outcomes. We examine patient and call-related characteristics associated with compliance with advice given in NHS 111 calls. The importance of health interactions that are not face-to-face has recently been highlighted by COVID-19 pandemic. In this retrospective cohort study, NHS 111 call records were linked to urgent and emergency care services data. We analysed data of 3,864,362 calls made between October 2013 and September 2017 relating to 1,964,726 callers across London. A multiple logistic regression was used to investigate associations between compliance with advice given and patient and call characteristics. Caller’s action is ‘compliant with advice given if first subsequent service interaction following contact with NHS 111 is consistent with advice given. We found that most calls were made by women (58%), adults aged 30–59 years (33%) and people in the white ethnic category (36%). The most common advice was for caller to contact their General Practitioner (GP) or other local services (18.2%) with varying times scales. Overall, callers followed advice given in 49% of calls. Compliance with triage advice was more likely in calls for children aged <16 years, women, those from Asian/Asian British ethnicity, and calls made out of hours. The highest compliance was among callers advised to self-care without the need to contact any other healthcare service. This is one of the largest studies to describe pathway adherence following telephone advice and associated clinical and demographic features. These results could inform attempts to improve caller compliance with advice given by NHS 111, and as the NHS moves to more hybrid way of working, the lessons from this study are key to the development of remote healthcare services going forward.

An analysis of NHS 111 demand for primary care services

“…Where contact was made with another service after the index call, this was most commonly presentation at an ED, which occurred in around 7% of cases and is similar to other studies using linked data (Lewis et al, 2021; Nakubulwa et al, 2022). Over 10% of these attendances were classed as non-urgent, i.e.…”

“…However, despite this, the rate of contact with primary care services was higher in this study than has been reported elsewhere. For example, Nakubulwa et al (2022) linked 111 call data with primary and secondary services in London between 2013– 2017 and reported only 35% of callers triaged to a primary care disposition had contact with a GP. In contrast, experimental statistics from NHS Digital suggest that patients in the Bradford area were less likely to attend a planned GP appointment than elsewhere in England in 2021.…”

Influencing healthcare seeking behaviours of consumers through a telephone health advice and triage service: a multi-method evaluation

“…Sometimes these services are used to provide a prescription to consumers where appropriate [10]. Telephone advice and triage lines are generally staffed by non-clinicians (or a mix of clinical and non-clinical staff) and rely upon data input to help guide decision making [12,13]. Advice provided in the latter is more generalised in nature and aimed to equip consumers with enough information to self-manage their care (when appropriate) or seek out appropriate avenues for further assessment and treatment.…”

Modelling NHS England 111 demand for primary care services: a discrete event simulation

“…In addition, the model was informed by relevant stakeholders and a linked dataset. However, it is nevertheless a simple working model, and does not take account of factors that have previously been associated with inappropriate ED attendance, such as age, sex, ethnicity and clinical input into the 111 call 6…”

“…Other studies examining caller behaviour and the impacts on the wider healthcare system5 6 have used datasets from 2017 and earlier, and patterns of activity identified then, may not be applicable now.…”