Introduction In 2018 the online NHS111 service was introduced in response to increasing and unsustainable demand for NHS111 telephone service. We explored user and staff perspectives of the online service to understand awareness and acceptability of the online service, how the online service is used and how it may affect demand for the NHS111 telephone service.

Methods We used data from the national online NHS111 user survey and telephone user survey for two NHS111 areas. We also undertook semi-structured interviews with 32 recent users of online NHS111 and 16 staff and stakeholders from NHS111 sites. We analysed data for 3728 online users and 795 telephone users in SPSS. Qualitative data was analysed using thematic analysis.

Results Online NHS111 was perceived as a useful low-risk, low-cost anonymous alternative to the telephone service that could be used instead of, or prior to calling NHS111, particularly for lower-acuity conditions. Staff and stakeholders characterised online and telephone 111 as separate services, with different audiences and purposes. User satisfaction and compliance with advice was lower for online than telephone NHS111 for all measures. Participants appeared to value advice from telephone NHS111 more highly, due to health adviser skills in probing and obtaining ‘soft information’. This was perceived to lead to more appropriate and trusted advice than online interactions, whose questions were considered over-simplified or inappropriate. However, the anonymity, lower pressure and low resource implications of the online service appeared to increase access to NHS111 services for a subset of users who would not otherwise access the telephone service.

Conclusions Online NHS111 has a useful role in the emergency and urgent care system, but as an adjunct to, rather than replacement of, telephone NHS111. Human interactions associated with the telephone service were seen as key to users obtaining appropriate and trusted advice in many instances.