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How could online NHS 111 reduce demand for the telephone NHS 111 service? Qualitative study of user and staff views
  1. Fiona C Sampson1,
  2. Emma L Knowles2,
  3. Jaqui Long1,
  4. Janette Turner1,
  5. Joanne Coster1
  1. 1 ScHARR, The University of Sheffield, Sheffield, South Yorkshire, UK
  2. 2 Audience Insights, National Institute for Health and Care Excellence, Manchester, UK
  1. Correspondence to Fiona C Sampson, ScHARR, The University of Sheffield, Sheffield, UK; f.c.sampson{at}


Background Online NHS111 was introduced in 2018 in response to increasing and unsustainable demand for telephone NHS111. Despite high levels of use, there is little evidence of channel shift from the telephone to the online service. We explored user and staff perspectives of online NHS111 to understand how and why online NHS111 is used and whether there may be potential for shift from the telephone to online service.

Methods As part of a wider mixed-methods study, we used qualitative semistructured interviews to explore perspectives of recent users of online 111 who had responded to a user survey (n=32) and NHS 111 staff (n=16) between November 2019 and June 2020. Interviews were recorded and transcribed verbatim. The data sets were analysed separately using framework analysis (user interviews) and thematic analysis (staff interviews).

Results Telephone NHS111 health adviser skills in probing and obtaining ‘soft information’ were perceived as key to obtaining advice that was considered more appropriate and trusted than advice from online interactions, which relied on oversimplified or irrelevant questions.

Online NHS111 was perceived to provide a useful and convenient adjunct to the telephone service and widened access to NHS111 services for some subgroups of users who would not otherwise access the telephone service (eg, communication barriers, social anxiety) or were concerned about ‘bothering’ a health professional. The nature of the online consultation meant that online NHS111 was perceived as more disposable and used more speculatively.

Conclusion Online 111 was perceived as a useful adjunct but not a replacement for telephone NHS 111 with potential for channel shift hindered by reduced confidence in the online service due to the lack of human interaction. Further development of OL111 algorithms will be required if it is to meet the needs of people with more complex health needs.

  • triage
  • emergency care systems
  • health service accessibility
  • qualitative research
  • urgent care

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  • Handling editor Alex Novak

  • Twitter @fcsampson

  • Contributors JT conceived the study, obtained research funding, oversaw the study and contributed to the analysis. ELK undertook user interviews and led the analysis of interview data. JL undertook user interviews and contributed to the analysis of interviews. FCS undertook staff interviews and analysis, led the converged analysis and drafted the article. All authors contributed to the research design. JC contributed to the analysis and drafting the paper. FCS drafted the article and ELK, JL, JT and JC critiqued the paper for important intellectual content. FCS takes responsibility for the paper as a whole and acts as guarantor.

  • Funding This paper presents independent research funded by the National Institute for Health and Care Research (NIHR HSDR 127655). The views and opinions expressed by authors in this publication are those of the authors and do not necessarily reflect those of the NHS, the NIHR, NETSCC, the HS&DR programme or the Department of Health and Social Care.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting or dissemination plans of this research. Refer to the Methods section for further details.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.