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Examining patient pathways and workforce implications of NHS 111 Online.

Why this is important

NHS 111 currently receives over 15 million calls each year. We want to look at the impact of NHS 111 Online.

Demand for GP and emergency care services is increasing and sometimes people don't use the most appropriate services for the health problems they have. Providing NHS 111 Online could help people to use the right services, and may provide advice that helps them do more self-care. However some research suggests that online systems can increase demand for other health services, and we know that not everyone finds online services easy to use.

We will look at the care pathways people follow after they use the online service and see if some people are less able to use this online system. We will also look at the work and staff needed to provide NHS 111 Online and we will compare our findings about the workforce to data from a similar system used in Australia to see how our service compares with theirs. We will also look at anonymised Twitter data to see what people are saying about NHS 111 services.


Because NHS 111 Online is being rolled out across England we cannot do an experiment to test how it works, so we will do detailed research (called case studies) in eight settings. We will ask people (using interviews and surveys), and observe what patients and staff do, to understand the online service. We will visit the chosen settings and talk to staff and managers about the work. We will use surveys to ask patients and potential patients about how easy the online system is to use and what they think about the system.

How this will benefit patients

We will write about our research to help the NHS make decisions about future services and we will feedback our findings during the project. Because the project is about an online service, we will also use social media such as Twitter and our own website to make sure that as many people as possible know about the project. We will have a patient and public group to advise us and make sure we communicate our findings in ways that can be easily understood.

Update: What's been happening

The research has had several pauses due to the prioritisation of Covid-19 studies across the country and the closure of some of our study sites to non-Covid-19 research.

Our full time researcher Jen has been briefly seconded to a Covid-19 research study to help out so we feel that our team has done our bit even if we are not part of the Oxford team developing the vaccine. Due to these pauses in the data collection we have revised the timeline for the project and plan to deliver our final report in the Autumn 2021.

To date we have had a fantastic response from primary care in three areas of England, and from charities who serve disadvantaged populations. This has resulted in 40 interviews to help us understand how NHS111 online is used and understood. These sites and NHS Digital have also helped us gather 1700 survey responses to date as part of our examination of eHealth literacy and people’s use of NHS111 online.

We will reopen the case-study data collection from April 2021 and we are continuing to collect survey responses. Our collaborators in Australia are making progress with the plans for interviews with stakeholders associated with the healthdirect service there.

Our Study Steering Group has met twice, and we have regular feedback meetings with stakeholders in NHS Digital & NHS Improvement and we are planning further work with patient and public groups to share interim findings. 


Oxford research team:

Further information:

Full project title: Ethnographic study of patient pathways and workforce implications of NHS 111 Online

Length of the project: September 2019 – August 2021


The study is funded by NIHR Health Services and Delivery Research Programme – grant number 127590.

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