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• Response to Emerg Med J 2006; 23: 911
  Jean Challiner
  Published on: 29 April 2016

• Published on: 29 April 2016

  Response to Emerg Med J 2006; 23: 911

  • Jean Challiner, Associate Medical Director NHS Direct
  • Other Contributors:
    • Mike Sadler

  Dear Editor,

  In response to your Original Article “Review of calls to NHS Direct related to attendance in the paediatric emergency department” Stewart, Fairhurst et al Emergency Medicine Journal 2006;23:911-914, we think it would be helpful to set some of the findings in context

  When NHS Direct was first set up, it was anticipated that in such a high profile service, the first national nurse telephone...

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  Dear Editor,

  In response to your Original Article “Review of calls to NHS Direct related to attendance in the paediatric emergency department” Stewart, Fairhurst et al Emergency Medicine Journal 2006;23:911-914, we think it would be helpful to set some of the findings in context

  When NHS Direct was first set up, it was anticipated that in such a high profile service, the first national nurse telephone clinical assessment service in the world, there would be a significant degree of risk aversion.

  The paper relates to circumstances in late 2002 and early 2003. The situation today is very different and so care needs to be taken in extrapolating the study’s conclusions to the present day. NHS Direct now works as a single virtual contact centre with calls being routed throughout England, the study relates to patients calling a single NHS Direct site. NHS Direct has made considerable changes to the decision support software - 10 new clinical versions have been released since the study - and to the training and culture of the organisation.

  One of the key drivers for these changes has been the need to reduce urgent referrals whilst maintaining our excellent clinical safety record. This we have done, and advice to callers supporting Home Care for under 16 year olds has increased from 15% for the study site in 2002/3, to over 26% nationally in 2005/6. Emergency and acute referrals have continued to fall overall1. We recognise that there is further progress to be made in this area, and are committed to continue to work with partners to ensure alignment with current best practice, new guidance, and learning from feedback, complaints and incidents.

  Telephone clinical assessment, especially of children, nevertheless needs constant careful development and the UK needs to reduce infant mortality to bring it into line with other European countries. To achieve this, and bearing in mind the comments of the author and Laird2 with respect to the difficulties of assessing sick children over the telephone, it is likely that a number of children who ultimately turn out to have a self limiting illness or injuries will need to be assessed in a face to face setting in order to identify, in a timely manner, others who are significantly unwell.

  During the past 2 years NHS Direct has introduced major upgrades to IT and telephony systems which will facilitate two way data exchange . NHS Direct would welcome the opportunity to work with colleagues on the ongoing development and audit of the outcome of referrals such as those reviewed in this study.

  1. Sadler M. NHS Direct reducing it’s A&E referrals. BMA News. 5 May 2005:9. 2. Colville Laird Primary Survey Emerg Med J 2006; 23: 891

  Mike Sadler Chief Operating Officer NHS Direct

  Jean Challiner Associate Medical Director NHS Direct

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  Conflict of Interest:
  None declared.

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