The future of the disastrous NHS 111 non-emergency phoneline has been thrown into chaos after one of its main providers announced plans to pull out of contracts across swathes of the country.

NHS Direct, which runs services in nine parts of the country, including London, Manchester, Merseyside and the West Midlands, said it was ending its contracts because the service was not financially sustainable.

It came after the company offered a public apology for significant problems when it launched two of the largest services in March.

An undercover investigation into the service found some centres have no qualified nurses to diagnose patients at weekends and ambulances are being sent out needlessly, putting extra strain on an already over stretched NHS.

In a statement, NHS Direct said it was seeking "to agree a managed transfer of NHS Direct's 111 services, and the frontline and other staff who currently provide them, to alternative providers."

It said: "NHS Direct is seeking to withdraw from the NHS 111 contracts it entered into as these have proved to be financially unsustainable."

The company said the most significant issue was that calls took more than twice as long as expected. As a result NHS Direct did not have sufficient capacity to handle all the calls that it received. Calls had to be diverted back to GP out-of-hours organisations and other phonelines.

Nick Chapman, NHS Direct Chief Executive said: "We will continue to provide a safe and reliable NHS 111 service to our patients until alternative arrangements can be made by commissioners. Whatever the outcome of the discussions on the future, patients will remain the central focus of our efforts, together with protecting our staff who work on NHS 111 to ensure that the service will continue to benefit from their skills and experience.”

The company said "no serious harm" had been caused by the difficulties.

NHS Direct is currently delivering NHS 111 in: Buckinghamshire, East London and the City, South East London, Sutton and Merton, West Midlands, Lancashire and Cumbria, Greater Manchester, Merseyside and Cheshire and Somerset.

In June NHS Direct wrote to local commissioners in North Essex and Cornwall and the Isles of Scilly to say it was not possible to mobilise their NHS 111 contracts.

In a documentary to be broadcast tonight, a manager at a call centre in Dorking run by another firm, private company Harmoni – which manages a third of 111 contracts in England - was secretly filmed and said: "We had a very bad service. Still realistically on the weekends we still are unsafe. We don't have the staff to deal with the calls that are coming in."

The service was supposed to relieve pressure on A&E units with call handlers providing non-emergency advice 24 hours a day, using a computer system to assess how un-well patients are. But this has led to A&E departments being likened to “war zones” because of the level of demands doctors are now facing.

The findings were exposed by two undercover reporters, posing as call handlers and secretly filming at 111 centres in Dorking and Bristol, who found people were waiting a long time for a call back from a clinician, and some times medical advice was given from people who weren’t clinicians.

Peter Carter, the Chief Executive of the Royal College of Nursing, called for "immediate intervention" at "governmental level".

The investigation follows a survey of GP practices, which found most were so unhappy about the 111 service they thought it should be abandoned.

Senior staff at more than 4,000 surgeries in England said that since the service was rolled out to most parts of the country earlier this year, pressures on Accident and Emergency departments have risen, while complaints from patients have increased.

The poll found 85 per cent of practice managers - those in charge of the running of surgeries - were so fearful about the safety of 111 that they believed the phonelines should be closed, and previous out-of-hours helplines re-instated.

But 65 per cent of practice managers said failings by the controversial service had increased the number of their patients ending up at A&E.

Almost half of the 4,600 practice managers polled said the number of complaints received from patients had increased since 111 was introduced. Patients have complained about calls going unanswered and poor advice being given, with frivolous calls being passed on to ambulance services, while serious concerns did not receive a prompt response.

Health officials launched an investigation into the advice line earlier this year, after a number of potentially serious incidents, including three deaths, were linked to 111.

The findings of the poll by Premier Patient Line, which provides telecom services to GP surgeries, follow a report from MPs last week which said the decision to roll out the service in April “premature”.
The report by the House of Commons Health Select Committee found that emergency services were becoming “unsustainable” as demand increased.

MPs said the botched introduction of the phonelines had not only failed to reduce pressure on casualty wards, but had actually encouraged patients to see A&E as their “first port of call” to avoid a “laborious triage process” and call handlers who were not trained clinicians.

A spokesman for Harmoni said: "We provide a clinically safe service. We expect all staff to only provide advice according to their role and their level of training and take a zero-tolerance approach to any breach. Our audits show no evidence of widespread poor practice."

They also described staffing levels as “robust” with one clinical advisor to every four health advisors.

A spokesman from NHS England said: “We know there have been problems with performance in some areas, mainly due to the local providers of 111 services having insufficient call handling capacity in place. NHS England has been clear with providers and commissioners that this is unacceptable and this has now been resolved.”

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