Q&A: NHS 111
The NHS in England has a new non-emergency care telephone number 111.
But the service has been plagued by problems. Here's what the new system was meant to do and what has gone wrong.
What is 111?
It is a free one-step number for patients with urgent, but not life-threatening symptoms.
The phone line operates 24-hours a day, seven days a week, although its busiest periods tend to be out-of-hours when local GPs are not available.
It was designed to replace NHS Direct, which was criticised for not being properly linked up to local health services.
For example, NHS Direct was not able to book out-of-hours GP appointments or call an ambulance. 111 can.
Who runs the service?
Whereas NHS Direct was a national operation, 111 is actually a series of local services.
There are 46 different services across England.
These are run by a combination of providers from ambulance services to private companies and the old NHS Direct service.
They are manned by trained call handlers. NHS Direct operated on a ratio of two call handlers to one nurse, 111 is often 15 call handlers to one nurse, according to the Royal College of Nursing.
Why has it been in the news?
Reports have emerged of patients facing long waits for advice, while emergency services have reported being inundated with patients who have been either incorrectly referred by 111 or unable to get any help at all.
The issue has been particularly pressing in A&E units, which were already struggling because of rises in admissions over recent years and the impact of the harsh winter.
It is unclear why this has happened. Some 111 services have had problems answering calls within the 60-second target, suggesting they do not have enough staff.
But doctors who have received referrals from 111 also claim patients are being sent to the wrong services.
Some areas have even struggled to get their services up and running.
By mid July five of the 46 services were still not live, while many of the others were relying on extra help from other parts of the health service to keep going.
Wasn't this supposed to have been resolved for the start of April?
Yes. Pilots actually started back in 2010 and the original deadline for a fully-running service was 1 April.
But last summer ministers relaxed the deadline after it became apparent some areas would not be ready.
It has now emerged that it will be the early part of 2014 before the final two services - Cornwall and north Essex - are up-and-running.
A review of the problems by NHS England found there was insufficient time from the completion of the pilots in the autumn to properly inform the creation of the service.
It also questioned whether the local commissioners had a "real understanding" of the capacity of the successful bidders to deliver.
One of the factors in the problems that have been encountered could be the squeeze on costs, it suggested.
The NHS Direct service, which 111 is replacing cost £20 per call, but most of the new contracts allow about £7.50 to £8.50.
What is happening with NHS Direct ?
The organisation, which used to run the old advice line, wants to end its contracts to run 111.
NHS Direct initially won 11 of the 46 regional contracts for the service, covering 34% of the population.
However, it cancelled two contracts before it even started answering calls in Cornwall and North Essex. It now wants to hand over its responsibilities for the remaining nine contracts.
It simply cannot afford to run the services. It warns that is "heading for a deficit of £26m if we continue to run the same volume of 111 services until the end of this financial year".
Ambulance trusts are likely to take over.
What happens if I call 111 now?
You will get the same service as before.
NHS Direct will continue to operate 111 where its nine contracts are up and running. At some point a "managed transfer" will take place so there will be no gaps in services.
Elsewhere in England the NHS 111 service will continue as normal, provided by ambulance trusts and private companies.
NHS 111 has not started in five regions. In those places, there will be a transition from the old NHS Direct and GP out of hours services to 111 by 2014.