Will online NHS 111 reduce demand for the telephone NHS 111 service? Mixed methods study of user and staff views

IntroductionOnline NHS111 was introduced in 2018 in response to increasing and unsustainable demand for Telephone NHS111. We explored user and staff perspectives of telephone and online NHS111 to understand how the two services were used, and whether and how online NHS111 had potential to reduce demand for telephone NHS111. MethodsWe used a convergent parallel mixed methods design, using data from the national online NHS 111 user survey and telephone user survey for 2 NHS 111 areas and semi-structured interviews with 32 recent users of online 111 and 16 NHS 111 staff. We analysed survey data for 3728 online users and 795 telephone users in SPSS, using chi-squared test for proportions and adjusting for age, sex, ethnicity and presence of long-term conditions. Qualitative data was analysed using Framework Analysis. ResultsTelephone NHS111 health adviser skills in probing and obtaining soft information were key to obtaining advice that was considered more appropriate and trusted than advice from online interactions, which relied on over-simplified or inappropriate questions. Telephone users were more satisfied with NHS111 than online users for all comparable measures, reported higher compliance with advice and were more likely to say they would have contacted another service if they hadnt used NHS111 (p<0.001). 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 (e.g. 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. ConclusionOnline 111 was perceived as a useful adjunct but not replacement for telephone NHS 111 with potential for channel shift hindered by reduced confidence in the online service. What is already known on this topicO_LIOnline NHS111 was introduced in the UK in 2018 to reduce unsustainable demand on the NHS111 telephone service. C_LIO_LIQuantitative routine data analysis showed that the introduction of online NHS111 had limited impact on demand for the NHS111 telephone service but does not explain how or why channel shift of demand from the NHS111 telephone service may not be happening. C_LI What this study addsO_LIUsers trusted and followed advice from telephone NHS111 more than online NHS111 due to the human interactions involved in answering questions appropriately. C_LIO_LIOnline NHS111 was used more speculatively and advice potentially seen as more disposable due to the lack of contact with health professionals. C_LIO_LIThe introduction of online NHS111 improved overall access to NHS111 services for a subset of users. C_LI How this study might affect research, policy, practiceO_LIOnline triage has limited potential for shifting demand due to ambiguity in algorithm question wording. C_LIO_LIRefinement of questioning will be required for online NHS 111 to increase in value and use for people with multimorbidity and long-term conditions. A hybrid option whereby online users can clarify question meaning using live chat options may improve the usefulness of online NHS111. C_LI