NHS Direct in England : fortieth report of Session 2001-02 / House of Commons Committee of Public Accounts.
- Great Britain. Parliament. House of Commons. Committee of Public Accounts.
- Date:
- 2002
Licence: Open Government Licence
Credit: NHS Direct in England : fortieth report of Session 2001-02 / House of Commons Committee of Public Accounts. Source: Wellcome Collection.
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![[Chairman Cont] 9. One problem that worries me is that NHS Direct takes on more and more workload. If you ring your GP out of hours, you are put through to him automatically and then, as we see in paragraph 3.11, that would become more and more within working hours. It is a very valuable service to people where they can ring their GP and talk to someone they know. We have already seen in recent years the virtual elimination of GPs being prepared to go out through the night so if you ring your GP at night you are put on to a locum. Are we going to have a system within four or five years whereby if you try and ring your GP you are not going to get through and you will be put through to somebody you have never met before, who no doubt is very competent but you just do not know them? (Mr Crisp) I do not think we have yet a clear position on what the access route to GP services will be in four or five years’ time. You have the pilots referred to here; you have also the people who are working in primary care collaborative, which is about developing access to GP services. They are establishing some of their own telephone services within the individual primary care sites. What is most important is that there is the partnership between NHS Direct and local GP premises so that we can get people to the right place. In some cases, that may mean that the GPs are dealing with the calls themselves; in other cases, it may mean that NHS Direct are the most appropriate people to deal with them. 10. That is interesting but you have not given me reassurance that people are going to continue to have the right to ring up their GP and talk to him or her. (Mr Jenkins) When the schemes of out of hours integration start, there are a significant number of patients who, perhaps because they do not know that the arrangements have changed or whatever, are a bit bemused. They say they would like to talk to their doctor. When they say that, we will pass them straight through to the doctor’s service. Two years down the road in the more established schemes, that question never arises and patients are quite comfortable. Their expectation is they will talk to a nurse. If we take patients and listen to their experiences, we do not have a problem. If we try and force a change that goes against what people want, then we get into difficulty. 11. What NHS services do you think are going to be most affected by NHS Direct in three or four years’ time? After all, this is now costing £99 million. Could that be spent better elsewhere on providing more hip operations or whatever? In that context, how do you see this developing and how is it going to affect the rest of the NHS? (Mr Crisp) It is complementary to the rest of the NHS. This report brings out the fact that effectively you can put together a cost analysis which suggests about half its costs are met by providing a different sort of service. I think it will be affecting the service quite significantly. I have been in contact with Surrey Ambulance Service where they now have a scheme whereby doctors referring patients to local hospitals go through the Surrey Ambulance system, which is linked in with NHS Direct and as a result people are not only able to equalise pressure between hospitals where patients are referred, but also a number of Ev 3 patients end up being offered some different sort of treatment, rather than admission to hospital. This is part of how we communicate and manage the NHS in a lot of different ways. You have talked about the examples of where we provide access to GP services. It is going to be quite widespread as a very significant way of getting information to patients and helping them to find the right bit of the service. Mr Rendel 12. My wife is a GP, just to declare an interest. We are told that in the White Paper that set up NHS Direct the aim was to provide easier and faster advice and information for people about health, illness and the NHS so that they are better able to care for themselves and their families. Is that still the aim of NHS Direct? (Mr Crisp) That is the essential aim, yes. 13. How do you measure whether you are getting better and whether you are enabling people to care for themselves and their families better? (Mr Crisp) There is quite a developed programme of asking people what they think. There is a significant amount of talking to patients about what they feel about the advice they are getting. You have also seen some of the evaluation studies that are taking place about whether or not, as a result of people ringing NHS Direct, they have decided to do something different from what they would have done beforehand. (Mr Jenkins) In some of the academic evaluations of NHS Direct, quite substantial caller surveys have probed about “has NHS Direct helped you to deal with a problem of this kind better as a result of the advice we have given?” We scored around 80 per cent in patient satisfaction. 14. I fully appreciate that patients are satisfied and that is good news. I wonder to what extent the patients saying they have changed what they otherwise would have done is realistic in the sense that, had they gone to the GP and had the advice given by NHS Direct been that they need another form of help, whether that would not have happened had they gone to the GP anyway. I wonder how you can measure whether NHS Direct has changed something that would have happened anyway? (Mr Jenkins) Yes, that might be true in some cases but we have allowed patients to do that from the comfort of their own home. We have that response to them available 24 hours a day, seven days a week when they perhaps could not contact their own GP. We have been perhaps able to give them time and reassurance that having to wait for the answer would have avoided. 15. They would not necessarily have had to wait for the answer if they had rung their GP. If you ring a GP in the middle of the day, you can sometimes get through. Equally, if you ring them at night, you may get through to a locum service which could give you advice perhaps as quickly as NHS Direct. (Mr Jenkins) In some cases that is true. The reason why so many people have used this service is a very strong indication that people do not perceive they are able to get those answers in the way you suggest. In](https://iiif.wellcomecollection.org/image/b32227814_0021.jp2/full/800%2C/0/default.jpg)
