A qualitative exploration of staff views towards the uptake of NHS Direct

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Highlights

  • Staff views are captured to examine the barriers and facilitators that impact on the uptake of NHS Direct.

  • This research has revealed that there are a core number of reasons why people do and do not engage with NHS Direct.

  • Policy makers should focus on supporting the public with increased knowledge and confidence in using telephone based healthcare systems to increase uptake.

Abstract

Objectives

To explore the views of staff to examine the underlying factors that may contribute to the variation of uptake to NHS Direct.

Methods

Adopting a qualitative approach two focus groups were carried out with staff (n=13); which included registered nurse advisors and health advisors at two NHS Direct sites: Bristol and Manchester in England. Findings were analysed using framework analysis [1].

Results

Staff views for explaining reasons why people do and do not engage with NHS Direct focused on themes centred on ‘knowledge of NHS Direct’, ‘attitudes towards NHS Direct’, ‘the cost of using NHS Direct’, ‘time/speed of using NHS Direct’ and finally ‘satisfaction with the service’.

Conclusion

This research has explored staff views of the barriers and facilitators that may impact on the uptake NHS Direct, which can help enable the development of future promotional campaigns that can target particular sections of the population to encourage use of telephone based healthcare services.

Introduction

The UK has become an advanced technology-driven society with telephone healthcare applications presented as not only a cost effective way to increase healthcare accessibility, but also a socially accepted integration delivery system that has become indispensable within healthcare practice [2]. NHS Direct has become a leading example of this, through the provision of nurse-led expert based health care advice and information in England, supporting patients to self-manage symptoms or signposting to appropriate health care services [3], [4]. NHS Direct has also become a popular service whereby in 2012 alone, including all commissioned services, it served around 8 million calls [5], becoming the world׳s largest telephone helpline service provider [6], [7].

The roll-out of the new 111 service, introduced to provide a more integrated non-emergency NHS healthcare telephone service [8] has subsequently marked the end of NHS Direct, with all operations set to be ceased by the end of this financial year (April, 2014) [9]. This therefore highlights the continued government commitment to providing technology driven healthcare within the UK. Further, as the UK continues to internationally lead the way, understanding how population groups engage in remote models of technology driven healthcare systems such as NHS Direct, becomes not only important nationally but also internationally as more countries worldwide adopt similar healthcare systems such as United States, Canada [10], [11], Australia [12], Sweden [13], Hong Kong, and France [14], [15].

There has been an associated rise in research investigating the uptake of NHS Direct. Evidence suggests that the highest users are predominantly women who call on behalf of children of 5 years old and under [16] with usage shown to be under represented in men [17], older people [18] and ethnic minorities [19] and those from poor socio economic groups [20], [21]. However, more current evidence has suggested that usage trends are highly dynamic with more newer studies challenging the prevailing conclusions [22], [23].

As we move from the optional NHS Direct service model to the mandatory 111 service uncovering access barriers of telephone based healthcare in relation to all out of hour׳s services becomes increasingly important. Moreover, with a core aim of NHS Direct and subsequently the 111 service is to improve cost effectiveness through the reduction unnecessary demands on other overstretched NHS services [24] access to this provision becomes paramount particularly in the midst of controversy surrounding the 111 service [25]. Therefore, through making use of telephone healthcare a mandatory aspect of the healthcare pathway and through the increasing need of cost reductions within there is an increasing need to make sure that this service can achieve equity to the diverse population within the UK. Whilst it is widely accepted that ‘a one size does not fit all’ approach is needed, policy makers need to be fully aware if either well defined strategies are needed to promote the service to particular sections of the population who are not engaging in the service, or provide alternative healthcare services to target these communities.

Low knowledge and confidence to use technology driven healthcare systems are viewed an artifact of the ‘digital divide’ [26], [27]. Whilst there is a limited research that has explored barriers, a consistent finding has been that that knowledge and awareness are core reason for low uptake [6], [28], [29], with research suggesting a greater proportion of women have heard of the service [20], with lowest awareness found in older age groups [20], [30]. Although, it is not clear if this remains a core reason at a more established time of the service. Confidence is also viewed as a high predictor of utilisation of technology based applications [31], [32] and research has shown that confidence to use telephone services is found in younger population groups with higher levels of education and income [33]. Therefore, it could be argued that confidence is fundamental in the adoption of NHS Direct but this concept has not been explored.

Attitudes towards using telephone based healthcare as a deviation from traditional ‘face to face’ healthcare services could also be viewed a barrier for certain population groups. For example, there is also a strong evidence base which has demonstrated that those who hold more positive attitudes towards face to face healthcare will hold more negative attitudes to ‘non-traditional’ services [34]. Within the adoption of telephone services [35], [36], [37], positive attitudes have focused on compatibility of existing practices, values, needs and experiences of healthcare with limited negative attitudes which included systematic barriers such as; time and the needs of the patient [38].

In summary, access to telephone based healthcare has become increasingly important given the Government׳s policy commitment to the new 111 service [8]. However, there has been no published research which has qualitatively explored access the views and attitudes of staff towards the uptake of such health services [39], [40], [41]. This study therefore aims to obtain a deeper insight through the views of NHS Direct staff (nurses and health advisors) who have directly provided expert telephone based healthcare to the public in England, on how the service is accessed, specifically to uncover the barriers and facilitators which may impact on the utilisation of telephone based health services.

Section snippets

Sampling and recruitment

This study took a qualitative approach to explore staff perspectives on the barriers and facilitators to using the service. Service providers have been shown to offer a valuable contribution of understanding patient experiences through their direct involvement in the use and delivery of telephone based services as a component of patient healthcare [42].

Focus groups were conducted in two research sites, Manchester and Bristol, UK. These sites, as well as recorded as having lower than average

Findings

Four themes emerged during the analysis of the transcripts. Barriers and facilitators towards using NHS direct were based on discussions of; ‘knowledge of NHS Direct’, ‘attitudes towards NHS Direct’, ‘the cost of using NHS Direct’, ‘time/speed of using NHS Direct’, and finally ‘satisfaction with other healthcare services’.

Discussion

This research has uncovered a range of staff views explaining reasons why some people do and do not engage with NHS Direct. The core themes of discussion centred on barriers and facilitators towards using NHS direct were based on discussions of; ‘knowledge of NHS Direct’, ‘attitudes towards NHS Direct’, ‘the cost of using NHS Direct’, ‘time/speed of using NHS Direct’, and finally ‘satisfaction with the service’,

Firstly there was a consensus by staff highlighting beliefs that the public had a

Ethical approval

Ethical approval was granted by the University of Bedfordshire ethics committee in March 2010 and the NHS Essex 1 ethics committee in April 2010 (REF: 11/H0301/8).

Funding

None.

Competing interests

There are no competing interests.

Acknowledgements

This research was jointly funded by NHS Direct and the University of Bedfordshire.

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  • Cited by (1)

    • Satisfaction of using a nurse led telephone helpline among mothers and caregivers of young children

      2016, Health Policy and Technology
      Citation Excerpt :

      Participants viewed self-care, however, this may not be the case for all sections of the population. For example, some people may prefer to be ‘cared’ for rather than being ‘empowered’ particularly found for older adults and those from diverse ethnic groups [61], who are worried about an illness for either them or a loved one [15]. This research has provided a valuable insight into the experiences of NHS Direct ‘users’, which has enabled a deeper understanding of the fundamental factors that impact on levels of satisfaction that may be extrapolated to other telephone based health services.

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