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Paediatric NHS 111 Clinical Assessment Services pilot: an observational study
  1. Philippa Anna Stilwell1,2,
  2. Gareth Stuttard3,4,
  3. Robert Scott-Jupp5,
  4. Adrian Boyle6,
  5. Simon Kenny1,7,
  6. Ian Maconochie1,8
  1. 1 Children and Young People's Transformation Team, NHS England and NHS Improvement London, London, UK
  2. 2 Community Child Health, Evelina London Children's Hospital, London, UK
  3. 3 Urgent and Emergency Care, NHS England and NHS Improvement Midlands, Birmingham, UK
  4. 4 General Practice, Wake Green Surgery, Birmingham, UK
  5. 5 General Paediatrics, Salisbury District Hospital, Salisbury, UK
  6. 6 Emergency Department, Cambridge University Hospitals Foundation Trust, London, UK
  7. 7 Paediatric Surgery, Alder Hey Children's NHS Foundation Trust, Liverpool, Merseyside, UK
  8. 8 Paediatric Emergency Department, St Mary’s Hospital, London, UK
  1. Correspondence to Professor Ian Maconochie, Children and Young People's Transformation Team, NHS England and NHS Improvement London, London, UK; ian.maconochie{at}


Objective To determine the feasibility and impact of having paediatric clinicians working in the Clinical Assessment Services (CAS) within NHS 111, a national telephone advice service.

Design Observational study.

Setting Six NHS 111 providers across England with CAS where volunteer paediatric clinicians (doctors and advanced nurse practitioners (ANPs)) worked between May and December 2020. A data reporting framework was used to compare the outcomes of calls taken by paediatric vs non-paediatric clinicians.

Patients Under 16-year-olds prompting calls to NHS 111 over the study period.

Main outcome measures The disposition (final outcome of calls) taken by paediatric versus non-paediatric clinicians, paediatric clinicians’ and patient experience.

Results 70 paediatric clinicians (66 doctors and 4 ANPs) worked flexible shifts in six NHS 111 providers’ CAS over the study period: 2535 calls for under 16-year-olds were taken by paediatric clinicians and 137 008 by non-paediatric clinicians. Overall, disposition rates differed significantly between the calls taken by paediatric versus (vs) non-paediatric clinicians: 69% vs 43% were advised on self-care only, 13% vs 18% to attend emergency departments (EDs), 13% vs 29% to attend primary care, 1% vs 4% to receive an urgent ambulance call out and 4% vs 6% referred to another health service, respectively. When compared with recent (all age) national whole data sets, the feedback from calls taken by paediatricians noted a greater proportion of patients/carers reporting that their problem was fully resolved (92% vs 27%).

Conclusions Introducing paediatric specialists into NHS 111 CAS is likely to increase self-care dispositions, and reduce onward referrals to primary care, ED and ambulances. Future work will evaluate the impact of a national paediatric clinical assessment service to which specific case types are streamed.

  • child health
  • child health services
  • emergency care
  • emergency service
  • hospital
  • paediatrics

Data availability statement

No data are available.

Statistics from


  • Contributors PAS contributed to the conception of the work and drafted and revised the manuscript. GS, RS-J, AB, SK and IM contributed to design and revised the manuscript. All authors approved the final version to be published and agree to be accountable for all aspects of the work. The contribution of AB was supported by the NIHR Cambridge Biomedical Research Centre (BRC-1215-20014). IM is guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Disclaimer The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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