NHS 111: If they tried, could they make the communication worse?


We recently received a communication from NHS 111 about a telephone encounter with one of our patients.

I have removed any identifying details, and I suggest you read it. This is supposed to let us, his GPs, know about the conversation.

If this were a parody, we would say it was over the top.

I actually spoke with this patient soon after this NHS 111 conversation. She/he was on a phone list, waiting for me to return her/his call. She/he had rung NHS 111 to ask the significance of a blood result. It would have been wiser just to wait for me to ring to discuss the result.

That this national programme should have planned for such a shockingly opaque format for communications is very very worrying.

Whoever you are, please go back to the drawing board.

Tower Hamlets CCG Chair letter to local MPs on Section 75 Regulations


2nd Floor Alderney Building

Mile End Hospital

Bancroft Road

London E1 4DG

Jim Fitzpatrick MP

Rushanara Ali MP

1st March 2013

Dear Jim and Rushanara,

Re: Section 75 Regulations and EDM 1104 (Early Day Motion)

We are extremely concerned about the regulations to bring into effect Section 75 of the Health and Social Care Act.

As commissioners we are determined to use all of the tools at our disposal to deliver the highest quality services for our patients and the people of Tower Hamlets.  To do this, we need to be able to commission integrated services which place the patient in control and provide a seamless passage across health and social care and through different health services.

Our view is that clinical commissioners must be provided with the freedom to use the full range of procurement tools including integration, collaboration, innovation pilots and a variety of competitive tendering mechanisms where appropriate. These must be based on achieving the highest quality and best value for patient outcomes rather than price alone, and give appropriate weighting to delivering the best care.  To do this we need to be free to choose what the most appropriate tool for any given situation is. Our concern is that the regulations laid under Section 75 of the Health and Social Care Act will be interpreted in a way that will obligate commissioners to carry out virtually all commissioning through competitive tendering.  This may negatively affect the way that seamless care can be delivered.

It is essential that CCGs are given greater freedom to choose when and how to procure new services and that the risk of referral to Monitor or the courts does not place a chilling effect on commissioners’ ability to take a more inclusive route if that is what they feel is best for patients, especially in relation to the care of complex patients, where services may be best provided by a small number of connected providers.

We all know that we face massive financial challenges in the NHS combined with managing a new system that has separated Primary (General Practice), Secondary (Hospitals) and Tertiary (Specialist) commissioning.

We do not underestimate this challenge and are determined to provide a high quality service for all our patients. Restricting our options will reduce our ability to provide the best for our patients and make it so much more difficult to manage the financial challenges.

I hope you feel able to support EDM 1104, which calls for a full debate on the issues raised by the Statutory Instruments laid under Section 75 of the Health and Social Care Act.

Best wishes

Dr Sam Everington


NHS Tower Hamlets CCG

3. If it is so stupid, why are they doing it?


I have reflected for over 2 years about this. If the proposal to allow patients to register with any GP in England, regardless of where they live, is so stupid, how is it that all three main political parties back the proposal, the Department of Health backs the proposal, journalists do not question the mechanics behind it, and, in the ‘Consultation’ over three quarters of the members of the public who responded allegedly backed the proposal?

I would say there are a variety of reasons, but all in the end come down to a misunderstanding of the situation, of the facts. This misunderstanding is the result of:


Ignorance (wilful and unwilful)

Stupidity (to different degrees, reaching at times the grotesque)

Misinformation (wilful and unwilful)



Being duped

Wishful thinking

Cognitive muddle

Brain damage

Corporate lobbying?

‘The Plot Against the NHS’

Bad Faith (a future post)

(other suggestions welcome)