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 19,361 people to A&E in June 2018, 25% of all callers. This is up from 20% in June 2014, when 13,151 patients were referred to casualty. That was the first year of full service for 111.

The service has become increasingly popular. West Midlands handled 78,858 calls in June 2018, up from 64,360 four years earlier.

It referred 57% of these to primary care, such as GP surgeries, pharmacies and dentists. About 4% of them were advised to rest at home.

Adam Steventon, Director of Data Analytics at the Health Foundation, said: “There is broad recognition that a large number of people calling NHS 111 are being directed to A&E and NHS England have stepped up the amount of clinical input available to those seeking help through this route to try and tackle this.

“In looking at the impact of making more clinicians available in NHS 111 call centres, we found that children and young people who were reviewed by a GP were less likely to go on to A&E than other patients. However, the lower levels of attendances were focused on minor treatment units, with little evidence that review by a GP reduced attendances at major A&E departments, which is where most of the pressure is.”

The Nuffield Trust last year warned about the increasing proportion of people being sent to A&E.

“The decision to scrap NHS Direct and replace it with the NHS 111 was strongly criticised by health professionals, and we have learned that NHS 111 is sending more callers, and a higher proportion, to A&E than in previous years, with great variations in performance across different regions,” the report said.