The battle for NHS 111: who should run it now?

General practitioners are on a collision course with senior civil servants over plans to give patients who dial the government’s 111 medical triage helpline the right to demand contact from a GP at their registered practice, an investigation by the BMJ has found.

Email correspondence between senior figures at NHS England obtained by the BMJ show a desire to insert new clauses into GPs’ contracts, which would allow notice of breach of contract to be served to GPs who failed to see or speak to patients who have been diverted from 111 call centres.

NHS England is also considering a plan to allow patients to book appointments with their GP directly through 111, as part of a drive to ease the pressure on hospital emergency departments.

But GP leaders said that plans to alter their contracts would be strongly resisted, as any such changes would overburden an already overstretched primary care system and undermine practices’ own triage mechanisms by effectively allowing remote lay call handlers to dictate to clinicians whether patients should be seen.

The investigation also shows that millions of pounds will be spent correcting the mismanagement of the service to date, after the litany of problems since its launch across England in April 2013.

Against this backdrop, further tensions have emerged over the future running of the 111 service, with GP out of hours cooperatives fearing a land grab from ambulance trusts as plans are drawn up to redesign the service.

Ambulance trusts currently run 111 services for most people in England (figure⇓). But GP out of hours cooperatives have said they were better placed to operate the …