The NHS 111 helpline in West Midlands is referring an increasing number of people to emergency services or calling an ambulance, prompting concerns about extra strain on A&E departments.
The latest figures released by NHS England show that West Midlands sent 21,981 people to A&E in November 2018, 25 per cent of all callers.
This is up from 16 per cent in November 2014, when 11,626 patients were referred to casualty. That was the first year of full service for 111.
NHS 111 is a 24-hour helpline for patients who need medical help but do not need to call 999, taking over from NHS Direct and GP out-of-hours services in 2014. The service has become increasingly popular. West Midlands handled 86,845 calls in November 2018, up from 73,523 four years earlier.
It referred 58 per cent of these to primary care, such as GP surgeries, pharmacies and dentists.
The service is commissioned by local clinical commissioning groups, which make spending decisions for local health services. The helplines are run by ambulance trusts, GP surgeries and private healthcare companies.
Nationally, there is significant variation in the number of A&E referrals by each service. Bristol, North Somerset and South Gloucestershire NHS 111 sent 27 per cent of all callers to A&E in November 2018, while Hertfordshire sent just 14 per cent.
NHS 111 replaced NHS Direct, which employed nurses and other clinical staff, in 2014. Now, most calls are dealt with by staff with no clinical background working to a set script, although around a fifth are referred to nurses or paramedics.
Although the number of callers referred to A&E is rising, Sarah Scobie, Nuffield Trust deputy director of research, said the NHS 111 is being effective at stopping people going to A&E unnecessarily.
She said: "A recent survey of NHS 111 users shows that 15 per ent of callers would have called 999 and almost a third would have gone straight to A&E if it hadn’t been for the NHS 111 service. NHS is under immense pressure as winter sets in. NHS 111 can help manage that pressure up to a point.
"It is likely that we will continue to see high levels of A&E visits and hospitals struggling to meet targets – something that has become a year-round pattern in the NHS."
A spokeswoman for the Health Foundation said the service is decisive to manage the pressure on the NHS during winter.
She said: "A greater proportion of these calls receive input from a clinician, however, the proportion of calls ending in an ambulance dispatch, or with a recommendation to attend A&E has not fallen. What is less clear is how many of these patients could be seen elsewhere.
"NHS 111 is experiencing a higher number of calls this year than this time last year and that shows this service remain an important way to manage the sustained pressure the NHS is likely to come under this winter."