REDIRECTING EMERGENCY CARE: A Study of the NHS 111 as a Gatekeeper in the British National Health Service

Abstract

This paper assesses the effect of the NHS 111 on alleviating pressures felt by Accident and Emergency departments across England as demand for their services increases. In order to extend the results past the NHS 111’s trial period, two methodological approaches are used. First, an individual-level probit model, alongside a linear probability model, is run to detect differences between users and non-users of the NHS 111: specifically, whether users of the NHS 111 have a different probability of experiencing long durations of stay, long waits before initially speaking with a doctor or a nurse, and satisfactory care. A difference-in-difference model is then used to evaluate the effect of the NHS 111 in the trial period in select hospitals from 2010-2012, using data aggregated at the hospital level. This model is used to investigate the effect of the NHS 111 on the trial hospitals’ average probabilities that a patient has a long duration of stay, a long wait before initially speaking with a doctor or a nurse, and satisfactory care. By combining both approaches, I conclude that the introduction of the NHS 111 has increased lengths of stay and initial wait times, and decreased patient satisfaction in the trial period. In later years, I find suggestive, but non-causal, evidence that the introduction of the NHS 111 has created a new pathway for demand and widened the regional differences apparent in A&E initial wait times, but that it has - through the implementation of reforms - reversed the initial drop in satisfaction levels.