Factors influencing appropriate referrals from NHS 111 to 999 services in Wales

Abstract

NHS 111 services aim to help people get the right advice and treatment when needed. The national NHS 111 service in Wales is delivered by Welsh Ambulance Services University NHS Trust. There have been reputational challenges associated with NHS 111 services and their referrals to emergency ambulance services (999) for many years. Welsh Ambulance Services University NHS Trust has seen lower levels of NHS 111 calls being referred to 999 services than most of the UK on a sustained basis. The authors argue that the trust's relative success derives not from being a sole provider, but rather from having a risk-empowered workforce that is enabled by acting as one organisational system with one organisational culture, supported through robust access to real-time data. The trust has also taken steps to challenge the common belief that excessive triage to 999 services is an acceptable byproduct of a ‘safe’ service. Instead, the workforce needs to be confident and competent to practice in a risk-stratified, balanced and often clinically autonomous way, through training, education, supervision, reflection and feedback. This article will provide an overview of the possible contributors to appropriate referrals from NHS 111 Wales to 999 services, aiming to stimulate useful conversation about the complex and multi-faceted issue.