In the recent article on the impact of the NHS Direct telephone
advice service on demand for immediate care (1) I was disappointed to see
that for nearly 70 000 calls, there was no impact on either attendances to
accident and emergency departments or ambulance services. The only
significant change was a marginal fall in the number of out of hour GP
consultations. Both in this study and in one into the patient satisfaction
with the service (2) approximately two thirds of the patients were advised
to contact either their GP or emergency services. The patients in this
latter study did report feeling reassured by the advice they received. The
articles have also come from a department closely involved in the scheme,
and therefore not entirely free from conflicts of interest in the
presentation of their findings.
The NHS direct was established to provide easy access to experienced
medical advice, with the aim of reducing unnecessary workload, in
particular for the emergency services. There has been significant
political backing for the project, as well as a large financial
investment. Given the findings, it seems a shame that the investment on
the project was not used to improve the current pre-existing services,
whereby patients can get advice and reassurance from medical staff who
would (ideally) have access to patient records. Whether or not there would
be a niche for a telephone advice service from the private sector is
another issue.
The authors state, on the one hand, that the service does not simply
represent an “extra step” for people to access medical services. On the
other, they state that the service “had little impact on the demand for
urgent health care.” Maybe things will change with time, but for the time
being the evidence seems to suggest that the NHS Direct is just another
step.
Yours faithfully,
Dr Adam Harper MBBS MRCP
1. Munroe J, Nicholl J, O’Cathain A, Knowles E. Impact of NHS Direct
on demand for immediate care: observational study. BMJ 2000;321:150-153
2. O’Cathain A, Munroe JF, Nicholl JP, , Knowles E. How helpful is
NHS Direct? Postal survey of callers. BMJ 2000; 320;1035
Rapid Response:
Telephone advice lines - all just hot air
Dear Sir,
In the recent article on the impact of the NHS Direct telephone
advice service on demand for immediate care (1) I was disappointed to see
that for nearly 70 000 calls, there was no impact on either attendances to
accident and emergency departments or ambulance services. The only
significant change was a marginal fall in the number of out of hour GP
consultations. Both in this study and in one into the patient satisfaction
with the service (2) approximately two thirds of the patients were advised
to contact either their GP or emergency services. The patients in this
latter study did report feeling reassured by the advice they received. The
articles have also come from a department closely involved in the scheme,
and therefore not entirely free from conflicts of interest in the
presentation of their findings.
The NHS direct was established to provide easy access to experienced
medical advice, with the aim of reducing unnecessary workload, in
particular for the emergency services. There has been significant
political backing for the project, as well as a large financial
investment. Given the findings, it seems a shame that the investment on
the project was not used to improve the current pre-existing services,
whereby patients can get advice and reassurance from medical staff who
would (ideally) have access to patient records. Whether or not there would
be a niche for a telephone advice service from the private sector is
another issue.
The authors state, on the one hand, that the service does not simply
represent an “extra step” for people to access medical services. On the
other, they state that the service “had little impact on the demand for
urgent health care.” Maybe things will change with time, but for the time
being the evidence seems to suggest that the NHS Direct is just another
step.
Yours faithfully,
Dr Adam Harper MBBS MRCP
1. Munroe J, Nicholl J, O’Cathain A, Knowles E. Impact of NHS Direct
on demand for immediate care: observational study. BMJ 2000;321:150-153
2. O’Cathain A, Munroe JF, Nicholl JP, , Knowles E. How helpful is
NHS Direct? Postal survey of callers. BMJ 2000; 320;1035
Competing interests - none.
Competing interests: No competing interests