Soon, dialing 111 in an emergency could be just as well-known as ringing 999. Health Editor Barry Nelson investigates the alternative service that is saving time and money.

NINE-nine-nine calls in parts of the North-East have fallen in the past three months because of an attempt to set up a non-emergency alternative.

It is an experiment which could transform the way out-of-hours health care is provided in the UK.

The Government is hoping that the pilot pays off, improving access to care and reducing the strain on emergency services.

From early July, anyone in County Durham and Darlington requiring non-emergency healthcare at weekends or in the evening when GP practices are closed has been asked to ring 111.

By dialling 111, callers have been put through to trained call handlers at the North East Ambulance Service control centre, in Newcastle. The handlers use sophisticated computer software to help them decide what service the caller needs, but they can also get advice from a nurse or a doctor.

The response of the call handlers can vary from simply giving advice on how to deal with the problem at home, to summoning a blue light emergency ambulance.

Most calls, however, are dealt with by arranging for callers to attend their nearest outof- hours urgent care centre, arranging for a home visit by a nurse or a doctor, or by booking a next day appointment at their local surgery.

Other options could include giving directions to the nearest 24-hour chemist or where they can see an emergency out-of-hours dentist.

The fall in 999 calls is a promising sign, according to Dr Will Richardson, an experienced County Durham GP who regularly does shifts at the Peterlee and Sunderland urgent care centres for the private out-of-hours health provider Primecare.

The latest figures from the 111 pilot show that since July 12 – when the new system went live – the dedicated control room in Newcastle has taken 31,500 calls.

Of those calls, 43 per cent led to treatment by members of a primary care out-of-hours team, either at an urgent care centre or walkin centre or through a home visit.

Another 19 per cent were dealt with by NHS community nursing services, while 13 per cent involved telephone advice from a nurse.

In six per cent of cases, the caller was advised to make their way to their local hospital accident and emergency department.

And, despite 111 being set up for non-emergency calls, in 11 per cent of cases the controller called for a 999 ambulance.

“The fact that more than one in ten callers ended up getting an ambulance is very reassuring in a way, because it means it is not ignoring serious illness,” says Dr Richardson, who combines his out-of-hours duties with working as a mainstream GP in Durham City.

“The ambulance service says it is getting about 200 fewer 999 calls a month since 111 came in.”

If there is a similar reduction in people turning up at A&E units during the same period, officials in the Department of Health will really sit up and take notice.

Dr Richardson, who has worked as a GP for nearly 20 years, can remember the days when out-of-hours services involved a GP sitting in a car waiting for a phone call giving instructions for the next home visit.

Since then, a network of NHS urgent care centres have been set up and GPs have opted out of providing out-of-hours cover – leaving the field to private firms such as Primecare, which work on behalf of primary care trusts.

It is early days, but Dr Richardson is impressed at what he has seen.

“The whole point of 111 was to put into place a system that was easy to use. I think it is working well,” he says. “It seems to be responsive, the phones are answered quickly and people are finding it easier to use.

“The great beauty of the system is that, within a few clicks, the call handler can see on their screen where the patient is, what service they need and how they can be married up. For example, if somebody needs a district nurse to change a dressing on a leg ulcer, the call handler can easily identify where the nearest district nurse service is going to be and either contact them directly or arrange for them to call.”

For Dr Richardson, the bottom line is that patients seem happier because they are getting to him more quickly.

“I think the new system is clearly speeding up the whole process,” he says. “Previously, somebody would have rung their GP, taken the emergency number down from the answering machine and then they would have been put in a queue to speak to a call handler.”

Even then the caller might have had to wait until they were phoned by a GP.

“It was really quite cumbersome. Now it is three digits and away you go,” he said.

So far, the distance patients sometimes have to travel does not seem to have been an issue.

Dr Richardson says: “The majority of people accept that you can’t have an urgent care centre on everybody’s doorstep.”

In cases where patients don’t have transport the 111 system has a range of vehicles available to tranfer people to the nearest urgent care centre – and take them home.

“There is everything from a Ford Focus to a modified Transit van where you can wheel somebody into the back. Even if it is from the top end of Teesdale the least we can do is to offer to take them home afterwards.”

Two months in, Dr Richardson is clearly impressed.

“I think the pilot has demonstrated that it is a workable system,” he says.

And that will be music to the ears of health ministers trying to reduce demand on hospital A&E units.