Exclusive: ‘Risk-averse’ NHS 111 algorithm piling pressure on ambulances
NHS 111 is piling the pressure on ambulances because medically untrained call handlers and "risk-averse" algorithms are sending paramedics to patients suffering with minor ailments such as period pain.
Patients struggling to get through to GPs are instead ringing 111, which uses an algorithm – a series of questions – to identify what is wrong with a patient and where to direct them.
Emergency doctors have warned that callouts for ambulances are up "20 to 30 per cent" up on normal, at a time when the NHS is trying to clear the backlog of care caused by the Covid pandemic.
Adrian Boyle, the vice-president of the Royal College of Emergency Medicine, said the problem was largely being driven by the NHS 111 algorithm that is "too risk-averse".
"What we find is that NHS 111 is more likely to send people to either the emergency department, or to the GP, or call for an ambulance, where they don't have a condition, where it's just some call handler following an algorithm," he told The Telegraph.
"Those algorithms are too risk-averse. They are less likely to tell people to self-care, and are more likely for them to go and seek clinical help."
When a call handler's decision on where to send a patient is not validated by a clinician – such as a GP, paramedic, or nurse – "you get lots of people being sent to areas of healthcare where they don't necessarily need to go", he added.
"We've always been aware that NHS 111, because of the nature of the algorithms and the lack of clinical involvement, sends too many people to emergency departments… it feels particularly bad at the moment," he said.
‘I think the whole system is under pressure’
Richard Webber, the national spokesman for the Royal College of Paramedics, said paramedics are waiting between three and four hours to hand over patients at emergency departments.
"It's frustrating when you know that the next call you get when you become available is for a patient who's waited quite a long time for an ambulance, because you've not been able to hand your patient over," he said.
Normally June and July would be a quieter period for paramedics, but currently activity is up "20 to 30 per cent on normal conditions".
Last month, the South Western Ambulance Service declared a "critical incident" and said some patients may wait longer for an ambulance while others may be advised to seek alternative medical treatment.
It is understood the pressures were related to the hot weather and an increase of visitors to the area. "It's got hot, the Covid wave has increased and everything's under pressure," Mr Webber said. "People obviously are struggling to get hold of GP appointments… so they ring 111 or 999. I think the whole system is under pressure."
One paramedic in the East Midlands told The Telegraph: "People can't get through to their GP about minor ailments so are told to phone 111 instead, which is notorious for sending ambulances [unnecessarily], and some people don't even try their GP any more – they just go straight to 111."
On one shift, the crew member said they had "three back-to-back" patients directed from 111, all presenting with non-emergency issues relating to "period pain".
The latest data from NHS England shows 1.88 million ambulances were dispatched by NHS 111 during 2020/21 (April to March) – an increase of more than 53,000 on the 2019/20 figures.
A NHS spokesman said: "Callers to NHS 111 are only referred to hospital when urgent care is needed, and the majority of people attending A&E have not contacted NHS 111 beforehand. The NHS has increased the number of doctors and nurses working in NHS 111 to ensure that the public get the right care for their needs and in the right place."
