England's health service helpline NHS Direct has been criticised in consumer research for providing callers with inconsistent advice. NHS Direct is a 24 hour telephone advice line first launched in 1998 and now covering over two thirds of the population of England. It was set up to provide fast advice and information on health issues or on the NHS. If patients call NHS Direct about specific symptoms they should be transferred by a call handler to a nurse who uses a computer package with guidelines on a range of conditions to prompt questions and assess what advice to give.
More than three million calls have been made to NHS Direct since it was launched. Researchers from the magazine Health Which? put the NHS Direct system to the test by telephoning different call centres and pretending to have common medical conditions. Three researchers each made 10 calls to NHS Direct. In each case they were briefed to play one of three roles: a 55 year old man with a history of heart attack and angina calling to get a repeat prescription of glyceryl trinitrate spray; a 60 year old woman with stomach pain likely to be caused by diclofenac tablets she had been taking for neck pain; the mother of a 5 year old girl with severe sickness, diarrhoea, and stomach pain.
Each call was made from a different part of England and to a cross section of NHS Direct sites using the three different computer systems used by NHS Direct. Every call was tape recorded and then analysed. A panel of experts, including GPs, a nurse, and a pharmacist, commented on the findings.
The researchers reported that the patient with angina spoke to a nurse in only four out of the 10 calls he made, with the rest being taken by call handlers. In only one call was the patient asked enough questions to clarify that his angina was getting worse. The woman with stomach pain spoke to a nurse each time she called NHS Direct, with all 10 nurses discovering she was taking diclofenac and eight observing that this could cause stomach pain. Only three nurses, however, suggested that she should stop taking the tablets.
The Health Which? study judged that the advice to the mother of the 5 year old girl was generally good but pointed out some inconsistencies. Seven nurses suggested painkillers, but one advised against their use. One nurse advised going to a hospital accident and emergency department. The advice should have been to treat the girl at home with fluids and painkillers.
The researchers argued that their research showed inconsistencies in the advice patients were given. They suggested that the angina case highlighted real deficiencies in the NHS Direct system, by failing to pick up a potential emergency. It also said that there was not enough liaison with GPs. Callers were asked for the name and address of their GP in only three out of the 30 calls.
Dr Steve George, reader in public health at the University of Southampton, argued that the Health Which? study was limited: “There was no control group—for example, comparing the advice given by NHS Direct with that provided by other services, such as GPs.” He has previously carried out research assessing the use of nurse-run telephone health advice lines and noted that advice from different professionals will always vary. “Securing consistency in professional advice is difficult. However, the use of computer based protocols means that NHS Direct is not only very safe but also one of the most consistent sources of health care advice for the public.”