Patient compliance with NHS 111 advice: Analysis of adult call and ED attendance data 2013-2017

PLoS One. 2021 May 10;16(5):e0251362. doi: 10.1371/journal.pone.0251362. eCollection 2021.


The NHS 111 telephone advice and triage service is a vital part of the management of urgent and emergency care (UEC) services in England. Demand for NHS 111 advice has increased since its introduction in 2013, and the service is of particular importance in light of the current pandemic and resulting increased demand for emergency care. Currently, little is known about the effectiveness of NHS 111 in terms of the appropriateness of the advice given, or about the compliance of patients with that advice. We aimed to address this issue by analysing a large linked routine dataset of all NHS 111 calls (n = 3,631,069) and subsequent emergency department (ED) attendances made in the Yorkshire & Humber region from March 2013-March 2017. We found that many patients do not comply with advice, with 11% (n = 289,748) of patients attending ED when they are advised to self-care or seek primary care. We also found that a considerable number of these patients are further classed as urgent (88%, n = 255,931) and a substantial minority (37%, 106,207) are subsequently admitted to hospital. Further, many patients who are sent an ambulance or told to attend ED are classed as non-urgent upon attending ED (9%, n = 42,372). This research suggests that the level at which NHS 111 is currently triaging results in many hundreds of thousands of mis-triaged cases annually. Additionally, patients frequently do not comply with the advice they receive. This has implications for understanding the accuracy and efficiency of triaging systems.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Ambulances / statistics & numerical data
  • Emergency Service, Hospital / statistics & numerical data
  • England
  • Hospitalization / statistics & numerical data
  • Hotlines / methods*
  • Humans
  • Middle Aged
  • Patient Compliance / statistics & numerical data*
  • Referral and Consultation / statistics & numerical data*
  • Triage / methods*
  • Young Adult

Grants and funding

This report is independent research funded by the National Institute for Health Research, Yorkshire and Humber Applied Research Collaborations. The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health and Social Care. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.