NHS 111: Online evaluation

An evaluation of the impact of online NHS11 on the NHS111 telephone service and potential effects on the urgent care system.



The NHS 111 telephone service is used to direct patients to appropriate services or provide self-care advice. It is being used increasingly by people who need help deciding which urgent care services to use when they need help quickly.

Recently, an alternative online NHS 111 service has been introduced across England to improve access to services and reduce the impact of growing demand for the NHS 111 telephone services. This is particularly important as demand for urgent care services continues to rise each year and difficulties in recruiting and retaining NHS staff make it even more difficult to meet this demand.

The online NHS 111 service was tested initially at four pilot sites in 2017. Since then, the service has expanded rapidly and became available to the whole population of England by the end of 2018. We have been funding to evaluate this new service and to assess the current and potential future impact of an online NHS 111 service on the NHS 111 telephone service. It is hoped that this research will help to support decisions about how future services can be developed and improved.


The aim of this study is to evaluate the impact of an online NHS111 service on the existing NHS111 telephone service and the wider EUCS. The main questions we will address are:

  • What impact does an online system have on the demand for the associated telephone service and other services both now and in the future?
  • Are there differences in the people who use the online and telephone services?
  • What are the experiences of people who use the online service?
  • What are the workforce implications of two different access points into the urgent care system?
  • What are the cost implications for the NHS?


We will address these questions using five separate research activities:

  1. We will review the current published evidence about telephone and online services to help access urgent care.
  2. We will measure the number of calls to the 111 telephone services and contacts with the online service over a four-year period in nine sites. We will use statistical analysis to measure any shift from the telephone service to the online service and estimate likely future demand for each service.
  3. We will use detailed online and telephone service routine data to understand who uses the service and how they may use other health services in future. We will also use the data from NHS 111 user surveys and carry out detailed interviews with online NHS 111 users to understand how they felt about how the service worked and how easy it was to use. 
  4. We will carry out detailed interviews with a range of staff and other stakeholders to understand how the new online service affects their workload and whether it has had any impact on the work and workload of the people who work at the NHS 111 telephone service. We will also explore whether there are any lessons for how services can be developed and improved.
  5. Estimate the cost consequences of the introduction of an online service on the telephone service and wider system.

By combining the results from the different research tasks we hope to be able to identify where online NHS 111 works well and whether changes are needed to improve the advice provided to people who use it, in order to make the service easier to access and use. We also hope to provide a broader picture of the overall impact on other urgent care services and assess how this might affect the future provision of NHS111 in terms of activity, service use and costs.

Project timetable

This is a 16-month funded research programme.

  • Initial set-up: Ethical and research governance permissions; Identification of routine data sources and data specifications; update of existing systematic review; development of surveys (four months, March - June 2019)
  • Routine data acquisition: Quantitative time series analysis of NHS 111 telephone and online service activity and processes; user surveys; online service detailed pathway analysis; qualitative interviews (nine months, July 2019 - March 2020)
  • Economic analysis : (four months, January - April 2020)
  • Data triangulation and write-up (four months, March - June 2020).



NIHR Health Services & Delivery Research Programme, project reference NIHR127655

Download the NHS 111 online protocol (PDF: 350kb)

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