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Scaling up: delivering a national 111 online service

NHS 111 online - - is now available across the majority of England, and digital uptake is rising month on month. In this blog, Debbie Floyd, from the NHS 111 online programme at NHS Digital, reflects on what she’s learnt from being part of delivering a large scale, digital change programme across the NHS.

By Debbie Floyd, 23 January 2019

Hand of someone walking down road holding phone with 111 Online up on the screen

Where do you go when you have an urgent medical problem? NHS 111 online began with this basic user need – we wanted to provide a fast, convenient alternative for people who would rather access urgent healthcare advice online.

Since 2017, I’ve had the pleasure of working with the NHS 111 online team. As coverage spreads and the service develops, reiterates and continues to evolve, here’s some of what we’ve learnt along the way.

Build something responsive, solid and safe

NHS 111 online is a mobile, responsive, digital healthcare service and can integrate with various system suppliers used in urgent and emergency care across England. The service is hosted in Azure and we were one of the first NHS Digital services to securely hold patient data in the public cloud; with the necessary robust levels of encryption and security. It is built entirely to the Government Service Standard and last year was approved to move into public beta.

Given the types of use cases we’ve seen, clinical safety is of paramount concern. The clinical content used to drive the triage is NHS Pathways, which also sits behind the NHS 111 telephone service. It has completed tens of millions of triages and has a strong clinical governance model. We’ve applied content design to the Pathways questions while retaining the algorithmic structure to make it suitable for use as a digital service.

Have a diverse team

Our multi-skilled team is spread out across the country, from Totnes to Blackburn, and Oxford, Birmingham, Leeds, London and Southampton. It includes software developers, clinical specialists, user researchers, implementation support and content designers, all working hand in hand. We’re an agile team, working in two-week sprints to iterate the service based on user research, responding rapidly to incremental changes and continually testing the product to make sure it meets the needs of users.

photo of a wall covered in different coloured post-it notes

Implementation teams provide hands-on support for local areas and our communications lead works with national and local organisations to ensure the service is promoted and communicated effectively across the country.

It works really well. Not every day, in every way, but there’s something that seems to resonate - and that’s that we work hard to deliver. There’s a huge respect for each other’s talents, but also a hefty acknowledgement that each of us are good at our different stuff.

Embrace and learn from cross-organisational working

NHS 111 online is a joint initiative from NHS England and NHS Digital and embedding the product across the NHS has been a complex challenge. We’ve built strong relationships with local commissioners in CCGs, NHS 111 providers and technical leads to ensure NHS 111 online is activated safely and consistently across England. We’re now live across most of England and NHS 111 online is also available through the new NHS App. The service is featuring in a national publicity campaign, positioning NHS 111 online as a key part of the overall NHS service offer.

We host a quarterly user forum that brings together regional teams from across the country - the invite list isn’t restricted because we want to hear from everyone. Whilst it’s essential to build a product based on user needs, we also want to ensure we’re working with colleagues to deliver something that has a positive impact on their health economies.

Be humble

The NHS is made up of so many different organisations and the array of systems, technologies, contracts and settings can be pretty mind-boggling. With this variety comes a host of different drivers and objectives. Respecting this has been key for us; we’ve had to learn quickly about commissioning or contracts.

We don’t know it all. Learning and iterating is at the core of the team’s philosophy and it’s really exciting to see some of the directions we can take the service in the future. We’ve seen a rise in the number of online journeys as a percentage of overall numbers calling the NHS 111 phoneline – from 2.7% in January 2018 to a current national average of 6.5%. The journey completion rate is around 90%.

Stay responsive

As the service grows, we’re working with more people to hear and understand their stories. Its great when we hear positive feedback that confirms we are  delivering a valued public service. One interviewee spoke of NHS 111 online “….I struggle with phone calls, so being able to use this online service helped me to be able to get some advice on my problem, without the anxiety of a phone call.”  An independent evaluation, commissioned by the National Institute for Health Research, is underway to help us understand and interpret data trends and usage.    It will report next year.  We’re also of course monitoring the impacts on usage to continuously track channel shift from phone to online.

With more than 450,000 online journeys made already on the service, we’re confident that the word is getting out, but there is always more to do. The drive for increasing digital uptake means we won’t stop collaborating.


head and shoulders of Debbie Floyd Debbie Floyd is NHS 111 Online Implementation Lead at NHS Digital.


Last edited: 25 January 2019 4:03 pm