NHS 111 is used about two million times a year by Londoners looking for urgent health advice. Helping service users access the right care as quickly as possible has significant implications both for individual users and for the capital’s highly pressured urgent and emergency care systems and services. In this blog, Senior Evaluation Manager Kate Lambe (supported by Senior Programme Manager Helen Sheldon and Senior Data Analyst Efejiro Ashano) discusses a recent project commissioned by NHS England – London to improve these pathways.
NHS 111 is often the first point of contact for people seeking urgent healthcare advice and support. In response, NHS England London Region worked with partners to introduce innovative digital pathways, smarter call routing, and AI-enabled technologies using Natural Language Processing (NLP).
In 2024 and 2025, the Health Innovation Network (HIN) South London partnered with NHSE London to support delivery of this work. The main aim of the partnership was to provide data-driven insights to inform NHSE’s decision-making on how more users of the 111 telephone service could be routed towards digital channels where appropriate, giving them faster access to care while reducing demands on services.
The HIN drew on existing data and conducted its own evidence generation activities to gain the perspective of patients and the public. This improved understanding of how people interact with the NHS 111 service and how increased uptake of digital offers to access care can most effectively be achieved.
The HIN’s two-year partnership with NHSE London focused on three main areas:
1. We engaged with patients and members of the public to understand the experience of the digital offer and barriers and facilitators to its uptake:
- We engaged directly with 66 patients (via workshops, focus groups and interviews).
- We analysed survey responses from 11,126 patients who had either accepted or declined the digital offer during a recent call to NHS 111.
2. Based on the insights from patients, we developed and tested new Interactive Voice Response (IVR) messaging. IVR is the automated system which initially triages patients ringing the 111 service using Natural Language Processing (NLP), before the service user is routed to a call adviser or other service. These changes were informed by the EAST behaviour change framework (make it Easy, Attractive, Social and Timely):
- We randomly trialled two new messages against the original messaging (control) across London, for all eligible pathways.
- We analysed the impact of the changed messaging using Statistical Process Control (SPC) and found digital uptake was between 7-12% higher in callers who received messaging focused on how “easy” it was to use the digital pathway. New messaging did not negatively affect 24-hour call-back rates.
3. Harnessing the positive trial results, the “easy” messaging was implemented across London for all appropriate eligible pathways. We continued to analyse data and found a sustained increase in digital uptake, moving from 17% uptake before the changes were made to 24% after the new messaging was implemented across eligible pathways.
We then used to simulate the impact of EAST messaging on digital uptake over a ten-year time horizon. System dynamics modelling is used to understand how complex systems are likely to behave over time, including various factors beyond the changes we had made which might impact demand or uptake. This modelling found:
- Digital uptake is likely to persist because it is driven by the changes we implemented in Interactive Voice Response (IVR) infrastructure, not by other expected changes in behaviour: the EAST change alone was four times more impactful in change in uptake compared to social factors which tend to influence adoption over time (e.g. word of mouth).
- Use of the EAST messaging closed the age gap in digital uptake: the intervention was most effective at engaging older users aged 46 and over, successfully reducing the gap in digital uptake that currently exists.
This transformation has expanded digital access options, streamlined patient journeys to digital channels, improved patient experience, and strengthened the resilience of NHS 111, helping more people access the right care through the most appropriate pathways.
Together, this work demonstrates how data‑driven insights and patient engagement can meaningfully strengthen the NHS 111 service. The partnership has laid the groundwork for a more resilient, digitally enabled urgent care system that better meets the needs of Londoners.