The Pharmaceutical Journal
Vol 271 No 7257 p40
12 July 2003

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Which? (www.which.net)

Which? questions NHS Direct advice

Advice from NHS Direct is inconsistent and sometimes dangerous, according to the consumer magazine Which? (July 2003, p10).

Furthermore, the level of service seems to be declining, with the advice being more likely to put patients at risk than when similar research was conducted by Health Which? in 2000. "It's clear the phoneline isn't functioning as it should," says Nikki Ratcliff, author of the report.

However, the methods used by Which? have been described as flawed by the Department of Health. The DoH has also criticised Which? for not sharing details of the research to allow NHS Direct to learn from it.

"NHS Direct takes the quality of its service very seriously and is constantly seeking to improve its performance in all areas. However, as yet Which? have not shared their research with us," a DoH spokesman said.

The Which? researchers posed as patients with one of three health problems and made 33 calls to 11 NHS Direct regional call centres. The calls were recorded by Which? and the advice received was evaluated by a panel of three health professionals — a general practitioner and two nurses.

The panel identified several areas of concern — long waits, potential emergencies being missed and a failure by NHS Direct staff to tailor questions appropriately.

On two occasions the researchers had to wait almost an hour for a nurse to call them back. More worryingly, on three occasions, the researchers did not receive a call-back at all.

One of the scenarios tested whether NHS Direct advisers could identify the risk of ectopic pregnancy. All but one adviser failed to stress this as a possible outcome. Many also missed the clues that suggested another researcher had unstable angina.

The researchers also found that advice given by NHS Direct Online and by the NHS Direct self-help guide was inconsistent. In addition, although easy to use, neither service allowed the researchers to explain their symptoms in full.

The DoH spokesman said the results needed to be interpreted with caution. "This small study of 33 calls to 11 NHS Direct centres cannot be relied upon to give a true picture of the advice given by NHS Direct," he said.

"We know through continual evaluation that NHS Direct has safely delivered health care advice and information to more than 18 million callers and on many occasions acted as a lifesaver. The service's excellent safety record has been highlighted many times through independent research, including evaluation by the National Audit Office," he added.