In December 1997, the UK government committed itself to creating “a new 24 hour telephone advice line staffed by nurses.”1 The first three call centres were operational three months later and 16 pilot sites, covering 60% of England, will have been established by the end of 1999. NHS Direct will be available throughout England by 2001.2 A fully networked system will then emerge, taking calls from an estimated 20% of the population each year. Wales will have its first call centre operational in April 2000 and Scotland will follow with its first pilot sites the same year.

Currently, 95% of calls are about symptoms but it is not the function of the telephone consultation to reach a diagnosis. The intention is to recommend further care or referral through a system of triage that reflects the nature and potential urgency of the clinical problem. Typically, 45–50% of all calls are about children and the highest level of use is from mothers of young children. Nurses answering the calls are supported by computer software that can guide questioning, help to weigh information for significance, and suggest optimal disposition according to local circumstances, including self care at home. There is integral access to corresponding advice and information databases, and electronic links should enable communication with primary care services, hospital accident and emergency (A&E) departments, the ambulance service, and other agencies. Calls solely for information are expected to increase with time.

NHS Direct is evolving rapidly with detailed development work going on behind the scenes, including efforts to form alliances with general practitioner cooperatives and other services. It is being strongly promoted as an integral part of the “New NHS”. £280 million (US$450 million) has been committed to it and to complementary projects over the next three years, on top of the …