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Review of NHS Direct research

NHS Direct and research studies

NHS Direct was established to “provide easier and faster information for people about health, illness and the NHS so that they are better able to care for themselves and their families” [Department of Health, 1997].

The growth in the use of telephone consultation for healthcare problems has developed partly in response to increased demand for GP and Accident and Emergency (A&E) department care [Bunn F, Byrne G, Kendall S, 2005].

The principal research studies that specifically consider the role and impact of NHS Direct are described below.

Launch of NHS Direct

When NHS Direct was first introduced, an observational study showing the patterns of use of NHS Direct and other immediate care services reported a small decrease in the use of co-operative GPs. However, no significant decrease was found in the use of A&E departments or ambulance services [Munro J, Nicholl J, O'Cathain A, Knowles E, 2000].

This evidence appears to suggest that the impact of NHS Direct at that time was as an additional out of hours provision.

The advice offered by nurses was well received: callers and service users found it reassuring.

Additional evaluation at the time of NHS Direct’s introduction showed that the service was mainly used by younger people and parents of young children. Although the over 70s tended to use the service less, they used it for more serious problems [Payne F, Jessopp L, 2001].

Socio-economic studies

In 2002, a population survey of over 15,000 people was conducted in the areas of Preston, Chorley, Newcastle, North Tyneside and Sheffield. The study showed that those from poorer socio-economic groups or with communication difficulties were less likely to have used NHS Direct than others [Knowles E, Munro J, O'Cathain A, Nicholl J, 2006].

These findings differed from those of an earlier study in South East London. It showed that calls to NHS Direct rise in areas of increasing deprivation, until at extreme levels of deprivation, they then decline [Burt J, Hooper R, Jessopp L, 2003].

Use of NHS Direct’s services

A postal survey of callers who had contacted NHS Direct between June 2004 and January 2005 with symptoms of either abdominal pain or a cough and sore throat was conducted. Of the 268 callers who responded:

• Over 90% reported they had followed the advice given by NHS Direct to self-care or to contact another health service.
• 51 callers were referred to an Accident and Emergency department and, of these, 39 (76%) received a prescription and 20 (39%) were admitted to hospital.
• 144 callers were referred to a General Practitioner (GP) and, of these, 88 (61%) received a prescription and 21 (15%) were admitted to hospital.
• Of the 69 callers advised to self-care, 47 (68%) reported that they did not receive any further intervention, while 18 (26%) reported they had subsequently contacted a GP and been given a prescription for medication.

The authors concluded that most referrals made by NHS Direct to another health service appropriate. However, a significant minority (26%) of callers referred to GPs did not receive any further intervention and there was some duplication of service use [Byrne G, Morgan J, Kendall S, Saberi, D, 2007].

Another study explored the transfer of non-urgent 999 calls for further advice and assessment to NHS Direct nurse advisors and found that transfer was safe and cost-effective.

The authors suggested that this type of service should be viewed as an enhanced triage system to aid increasingly complex decisions about which emergency care resources to send and when [Turner J, Snooks H, Youren A, Dixon S, Fall D, Gaze S et al, 2006].

References

1. 1. Department of Health. The new NHS. Cmd 3807. 1997. London Stationery Office.
2. 2. Bunn F, Byrne G, Kendall S. The effects of telephone consultation and triage on healthcare use and patient satisfaction: a systematic review. British Journal of General Practice 2005; 956-961.
3. 3. Munro J, Nicholl J, O'Cathain A, Knowles E. Impact of NHS Direct on demand for immediate care: observational study. British Medical Journal 2000; 321:150-153.
4. 4. Payne F, Jessopp L. NHS Direct: review of activity data for the first year of operation at one site. Journal of Public Health Medicine 2001; 23(2):155-158.
5. 5. Knowles E, Munro J, O'Cathain A, Nicholl J. Equity of access to health care. Evidence from NHS Direct in the UK. Journal of Telemedicine and Telecare 2006; 12(5):262-265.
6. 6. Burt J, Hooper R, Jessopp L. The relationship between use of NHS Direct and deprivation in southeast London. Journal of Public Health Medicine 2003; 25(2):174-176.
7. 7. Geraldine Byrne  Janice Morgan  Sally Kendall  and Debbie Saberi: A survey of NHS Direct callers' use of health services and the interventions they received. Primary Health Care Research & Development. (2007), Vol 8: 91-100 Cambridge University Press
8. 8. Turner J, Snooks H, Youren A, Dixon S, Fall D, Gaze S et al. The costs and benefits of managing some low-priority 999 ambulance calls by NHS Direct nurse advisers. 2006. Report for the National Co-ordinating Centre for NHS SDO R&D.