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Paramedics' perceptions and experiences of NHS 111 in the south west of England

02 June 2020
Volume 12 · Issue 6



NHS 111 is a non-emergency telephone triage service in England, where people with non-urgent health problems or questions can gain access to information and services. However, studies have demonstrated key problems with the burden it places on emergency and ambulance services.


To add to the evidence base, this study explores the perceptions and experiences of paramedics who attend patients referred to the ambulance service by NHS 111.


A qualitative research design was adopted and seven frontline paramedics who work in the south west of England were interviewed. Data were collected using semi-structured interview questions and thematically analysed.


Key overarching themes identified included: non-clinical call handlers making clinical decisions; caution and liability; an unwarranted, increased demand on the ambulance service; inaccurate call prioritisation; and interprofessional conflict.


Improvements need to be made to the NHS 111 service to ensure the triage software it uses is triaging and prioritising patients accurately and to minimise inappropriate referrals to the ambulance service, promoting the right care for patients the first time.

Healthcare organisations throughout England collaborate to deliver NHS 111, which is a non-emergency clinical advice and triage service in England (Dayan, 2017; NHS Improvement, 2018). NHS 111 call handlers are non-clinical staff who use a triage software called NHS Pathways to determine the services and support required. Call handlers refer a large portion of callers (one-fifth) to clinicians working for NHS 111, such as paramedics, where cases are complex and require deeper investigation (Dayan, 2017).

NHS 111 supersedes NHS Direct. The transition was completed in 2013. However, Triggle (2013) reported there were inconsistencies in its rollout across different services and providers, which hindered its effectiveness. Between 2011 and 2013, a pilot study revealed that this led to fragmented and chaotic emergency service provision across England (Turner et al, 2012; Dayan, 2017).

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