NHS 111 online is a Class 1 medical device

NHS 111 online is a triage system available for members of the public in England and uses clinical content from NHS Pathways to enable users to go through a digital remote triage process to get to the most appropriate level of care for their presenting health care needs. 111 online uses the Directory of Services (DoS) to refer patients to locally commissioned services that best meets the online user’s needs.

The system is owned by the Department for Health and Social Care, commissioned by NHSX and developed and delivered by NHS Digital

The system is built around a clinical hierarchy, meaning that life-threatening symptoms are assessed at the start of the online journey, progressing through to less urgent symptoms which require a less urgent response (or disposition) in other settings.  NHS 111 online is not a diagnostic system and only assesses symptoms presented at the time of the interaction to refer or advise users to contact the most appropriate level of care for their presenting health care need.

People who access NHS 111 online enter their age, sex at birth, postcode and are guided to seek help for their main concerns and where symptomatic triage is required, they are then asked a series of questions based on their main presenting symptoms in line with the clinical hierarchy of NHS Pathways.

NHS Pathways is an interlinked series of algorithms, or pathways, that link questions and care advice leading to clinical endpoints known as “dispositions”. The system presents a series of questions in order that the most appropriate clinical response or disposition may be determined based on the answers given. A disposition will specify the skill set and time frame that a patient requires. The system triages both injury and illness presentations for users over the age of 5. In addition, special populations are included where relevant to the triage for example pregnancy.  

The NHS Pathways system was developed and is maintained by a group of experienced NHS clinicians (clinical authors) with an urgent and emergency care background. The NHS Pathways clinical authoring team come from a variety of clinical backgrounds and are either a paramedic, nurse or doctor who are registered, licensed practitioners.

NHS 111 online is an accessible and convenient alternative to the NHS 111 telephone service and provides an option for people who want to access NHS 111 digitally. 

REF NHS 111 online

SN v1.3 Approved by: Jacqueline Jedrzejewski, Deputy Director of Digital Development / Clinical Assurance Lead, NHSX

On: 7 October 2019

NHS 111 online is for use in England only.

111 online advises members of the public what to do and where to get help based on their answers to questions about their symptoms.

For some outcomes, 111 online can electronically refer users to a healthcare provider. It also offers self-care advice where appropriate. 

111 online is based on User Centred Design principles so that no training is required for the public to be able to use the service. Content is carefully designed to be self-explanatory and triage features (such as radio buttons and text entry boxes) intuitive.

The 111 online website is designed and intended for use:

• only by people who live in England; and

• are over 5 years of age; and

• by individuals in accordance with the embedded instructions for their own personal and domestic use without any additional support - the use of this website other than for domestic or private use (for any use other than by the patient, or their carer) is outside of the clinical safety case that governs its use - examples of this would be, but not excluded to, use by a third party call handler or use within a care setting.

The use of NHS 111 online is contraindicated as follows:

• people under the age of 5

• not intended to make treatment decision following admission to hospital

• not intended to predict the expected outcomes of patients under different treatments

• not intended to automatically remove people from a high risk group or to deny anyone care

Not intended for gaming/malicious use – the tailoring of answers by users to reach inappropriate dispositions

Pre-use requirements and dependencies

Use of 111 online is available through any web browser.

License agreement

Commissioners of provider services (clinical commissioning groups) using NHS 111 online must sign an End User Agreement with NHS Digital.

The NHS 111 online team supports end users in meeting the minimum standards but are not responsible for ensuring they do so.

Host systems

The NHS 111 online system is a stand-alone system that can refer people to local services. 111 online is available via a standard internet connection and his hosted on Microsoft Azure infrastructure.

Software installation, upgrade and configuration

This version of NHS 111 online is available via the URL https://111.nhs.uk/, it can be accessed anywhere there is an internet connection. 

NHS 111 online is connected to the live Urgent and Emergency Directory of Service (DoS) and uses the DoS to show commissioned and locally available services to users for their clinical need.

The NHS 111 online web architecture also relies on open-source components whenever possible and uses open standards. Contracts for external services, like Microsoft Azure, are subject to NHS Digital’s internal controls that ensure commercial agreements have clear requirements.

NHS 111 online is a website and therefore no downloads or configuration steps are required to use the service.

NHS 111 online is based on user centred design principles so that no training is required for the public to be able to use the service. Content is carefully designed to be self-explanatory and triage features (such as radio buttons and text entry boxes) intuitive.

NHS 111 online is designed to be used by as many people as possible. We use clear and simple language suitable for people with a reading age of between 9 and 12 years.

The website can be used on most web browsers. Users should be able to:

• change colours, contrast levels and fonts

• zoom in up to at least 300% and still see all the content

• navigate using just a keyboard

• navigate using speech recognition software

• read using a screen reader, including JAWS, NVDA and VoiceOver

The following support is available:

• NHS 111 online has 24 hour a day, 7 days a week support available to suppliers and connected services via the NHS Digital National Service Desk. An on-call rota ensures that operational, clinical, and technical expertise is always available to resolve immediate problems
• service users are able to submit feedback through comments and surveys. These inform the product managers and user research team of emerging opportunities to implement improvements and create new features
• users are also able to get in touch with questions about the service via [email protected] - we do not reply to requests for medical help
• NHS 111 Online has a dedicated data team that monitors the use of the service and enables the service to be developed in line with current demand profiles
• NHS 111 Online has a dedicated product management, technical and clinical team to enable constant monitoring of the service and the development of the service in line with user needs
• NHS 111 Online is a directly provided NHS Digital service and any risks or incidents associated with the product are robustly managed through NHS Digital’s internal clinical governance process

NHS 111 online uses HTML, CSS and JavaScript.

NHS Digital is committed to making its website accessible, in accordance with the Public Sector Bodies (Websites and Mobile Applications) (No. 2) Accessibility Regulations 2018 (the ‘accessibility regulations’).

This website is partially compliant with the Web Content Accessibility Guidelines version 2.1 AA standard, due to the non-compliances listed below.

The content listed below is non-accessible due to non-compliance with the accessibility regulations:

• interactive maps - screen readers will skip the maps, but addresses and other information are provided alongside any map in text form - fails under WCAG 2.1 section 4.1.2 (Name, role, value)

• consistent use of landmarks - fails WCAG 2.1 section 1.3.6 (Identify purpose)

• consistent use of error validation alerting for screen readers - fails WCAG 2.1 section 3.3.1 (Error identification)

NHS Digital
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