Health bodies call for drugs to be decriminalised

Two leading public health organisations have called for the possession and personal use of all illegal drugs to be decriminalised in the UK.

Two leading public health organisations have called for the possession and personal use of all illegal drugs to be decriminalised in the UK.
The Royal Society for Public Health and the Faculty of Public Health said the government’s approach to drugs policy had failed.  There should be a greater focus on treatment and education, they added.

The report, called Taking A New Line On Drugs, said criminal sanctions failed to deter illegal drug use, undermined people’s life chances and could act as a barrier to addicts coming forward for help.

It called for a “sea change in approach” and said the UK should adopt the Portuguese system under which people caught using drugs were offered treatment and support rather than being punished. However, dealers and suppliers would still be prosecuted.

The report also suggested that drugs education be made mandatory, and that responsibility for drugs policy be moved from the Home Office to the Department of Health.

Royal Society for Public Health chief executive Shirley Cramer said: “For too long, UK and global drugs strategies have pursued reductions in drug use as an end in itself, failing to recognise that harsh criminal sanctions have pushed vulnerable people in need of treatment to the margins of society, driving up harm to health and wellbeing even as overall use falls.

“On many levels, in terms of the public’s health, the ‘war on drugs’ has failed.”

“The time has come for a new approach, where we recognise that drug use is a health issue, not a criminal justice issue, and that those who misuse drugs are in need of treatment and support – not criminals in need of punishment.”

Baroness Molly Meacher, speaking on behalf of the All-Party Parliamentary Group for Drug Policy Reform, welcomed the report.

She said the current system “criminalises some users of psychoactive drugs whilst very harmful psychoactive drugs including alcohol and tobacco remain legal”.

A Home Office spokesman said: “The UK’s approach on drugs remains clear – we must prevent drug use in our communities and support people dependent on drugs through treatment and recovery.

“At the same time, we have to stop the supply of illegal drugs and tackle the organised crime behind the drugs trade.”

The spokesman said there had been a drop in drug misuse over the past decade and more people were recovering from dependency now than in 2009-10.

Health Direct has for a long time noted the costly failure that is the current policy on drugs. On August 02, 2006 in Risks of taking drugs compared- Scientific review of dangers of drugtaking- Drugs, the real deal we reproduced the first ranking based upon scientific evidence of harm to both individuals and society.

It was devised by government advisers – then ignored by ministers because of its controversial findings. The analysis was carried out by David Nutt, the then senior member of the Advisory Council on the Misuse of Drugs, and Colin Blakemore, the chief executive of the Medical Research Council.

NHS health staff crisis is worse than cash woes

The growing crisis in healthcare professionals’ morale is a greater risk to the NHS than the financial problems it is grappling with.

The growing crisis in healthcare professionals' morale is a greater risk to the NHS than the financial problems it is grappling with
Nigel Edwards, chief executive of the Nuffield Trust think tank, warned staff shortages, disputes with government and bullying were creating a “toxic mix”.

He said if the problems persisted, the affinity staff felt for the NHS could be irreparably broken.

The warning comes amid growing tensions between the healthcare workforce and government ministers.

This year has seen a series of strikes by junior doctors in England, while nurses and midwives have been protesting about plans to scrap the bursaries they receive while they are studying.

Mr Edwards said this industrial unrest was happening at a time when there were looming shortages – last month, a report by the Public Accounts Committee warned the NHS was short of about 50,000 staff out of a front line workforce of just over 800,000.

The most recent staff survey – published earlier this year – also highlighted the problem, with only 31% of respondents saying there was enough staff for them to do their jobs properly.

The Nuffield Trust also pointed to feedback it had received from health managers warning about deteriorating morale and uncontrollable growth in workload.

One manager said there was a “creeping sense of inevitability and acceptance that failure will happen at some point”.

Mr Edwards said the care and compassion of health workers was underpinned by a “psychological” contract.

He said while financial problems – last month it was revealed NHS trusts had overspent by a record £2.45 billion in 2015-16 – could be rectified in time, deteriorating morale was harder to fix.

“Once the psychological contract with staff is broken, it may be impossible to reverse,” he added.

Siva Anandaciva, of NHS Providers, which represents NHS trusts, said he shared the concerns. “This is a pivotal time for the NHS, with extreme financial and capacity challenges putting extra pressure on staff,” he said. “Perhaps inevitably, staff morale can take a battering.”

A Department of Health spokeswoman said there were signs in the staff survey that some measures were improving.

She added: “Good leadership is the single most critical ingredient to raising morale in any team. We also see that the best hospitals combine tight financial grip, an unrelenting focus on improving patient care and high levels of staff engagement.”

Health Direct notes frequent HR research which finds that levels of staff morale inversely correlates with managements’ staff appreciation in many organisations- the NHS is no expection Mr Hunt.

Agreement in sight for Junior doctors’ contract deal

A potential deal in the long running dispute over a new junior doctors’ contract has been agreed.

AgreementGovernment negotiators and the British Medical Association leadership have reached an agreement after eight days of talks at conciliation service Acas.

Health Secretary Jeremy Hunt said the deal was a “significant step forward”, while the BMA said it represented the “best and final way” to end the row.

The offer will now be put to a vote of over 40,000 BMA members.

That means it could still end up being rejected, but the fact the union and government have agreed a deal to end the stalemate is a major breakthrough.

These talks were seen as the last chance to get an agreement and were set up after a series of strikes, including the first ever full walk out by doctors.

It comes after the government announced in February it would be imposing the contract from this summer after previous talks failed.

The details released this week include several major changes:

  • the basic pay rise is to be reduced from 13.5% to between 10% and 11%
  • weekends will no longer be divided up between normal and unsocial hours, instead a system of supplements will be paid which depend on how many weekends a doctor works over the course of a year
  • extra pay for night shifts is to be reduced from 50% to 37%
  • extra support will be made available for doctors who take time out, such as women who go on maternity leave, to enable them to catch up on their training and thus qualify for pay rises – after claims women were being unfairly penalised
  • junior doctors will get an enhanced role in advising and liaising with the independent guardians who keep an eye on the hours doctors work
  • the deal remains cost neutral, which means the government is not putting in extra money

The fact that something has been agreed is a major breakthrough. But this dispute is still a long way from being over. The BMA has promised its 40,000 members a vote on the agreement. That will be carried out in June and there are no guarantees the membership will give it the green light.

Junior doctors have been incredibly united throughout. Some 98% voted in favour of taking strike action last autumn and whenever union leaders have taken soundings since, the overwhelming sense has been that they have wanted to fight on.

If this hadn’t been the case the leadership would probably have agreed a deal long before now. What will be interesting, and perhaps crucial, is just how strongly the BMA leadership tries to sell the agreement to members in the coming weeks.

BMA junior doctor leader Dr Johann Malawana said he was pleased to have reached a deal after “intense but constructive talks”, adding it was the “best and final way” of resolving the dispute.

“Junior doctors have always wanted to agree a safe and fair contract, one that recognises and values the contribution junior doctors make to the NHS, addresses the recruitment and retention crisis in parts of the NHS and provides the basis for delivering a world-class health service.”

“What has been agreed today delivers on these principles, is a good deal for junior doctors and will ensure that they can continue to deliver high-quality care for patients.”

He said he would be recommending the deal to junior doctors ahead of the vote of BMA members, which will be run in June.

Jeremy Hunt- lies bullshit and poisoned statistics pt 2

Following one from Health Direct’s Jeremy Hunt- lies bullshit and poisoned statistics post yesterday.

Following one from Health Direct's Jeremy Hunt- lies bullshit and poisoned statistics post yesterdayHealth secretary Jeremy Hunt and the claim he made about doctors’ contracts

So, is it true? Do 6,000 people — or 11,000 — die needlessly in NHS hospitals because of poor weekend care? Nobody knows for sure; Jeremy Hunt certainly does not. It’s not enough to show that people admitted to hospital at the weekend are at an increased risk of dying there. We need to understand why — a question that is essential for good policy but inconvenient for politicians.

One possible explanation for the elevated death rate for weekend admissions is that the NHS provides patchy care and people die as a result. That is the interpretation presented as bald fact by Jeremy Hunt. But a more straightforward explanation is that people are only admitted to hospital at the weekend if they are seriously ill. Less urgent cases wait until weekdays.

If weekend patients are sicker, it is hardly a surprise that they are more likely to die. Allowing non-urgent cases into NHS hospitals at weekends wouldn’t save any lives, but it would certainly make the statistics look more flattering. Of course, epidemiologists try to correct for the fact that weekend patients tend to be more seriously ill, but few experts have any confidence that they have succeeded.

A more subtle explanation is that shortfalls in the palliative care system may create the illusion that hospitals are dangerous. Sometimes a patient is certain to die, but the question is where — in a hospital or a palliative hospice? If hospice care is patchy at weekends then a patient may instead be admitted to hospital and die there.

That would certainly reflect poor weekend care. It would also add to the tally of excess weekend hospital deaths, because during the week that patient would have been admitted to, and died in, a palliative hospice. But it is not true that the death was avoidable.

Does it seem like we’re getting stuck in the details? Well, yes, perhaps we are. But improving NHS care requires an interest in the details. If there is a problem in palliative care hospices, it will not be fixed by improving staffing in hospitals.

“Even if you accept that there’s a difference in death rates,” says John Appleby, the chief economist of the King’s Fund health think-tank, “nobody is able to say why it is. Is it lack of diagnostic services? Lack of consultants? We’re jumping too quickly from a statistic to a solution.”

“When one claim is discredited, Jeremy Hunt’s office simply asserts that another one can be found to take its place”

This matters — the NHS has a limited budget. There are many things we might want to spend money on, which is why we have the National Institute for Health and Care Excellence (Nice) to weigh up the likely benefits of new treatments and decide which offer the best value for money.

Would Jeremy Hunt’s push towards a seven-day NHS pass the Nice cost-benefit threshold? Probably not. Our best guess comes from a 2015 study by health economists Rachel Meacock, Tim Doran and Matt Sutton, which estimates that the NHS has many cheaper ways to save lives. A more comprehensive assessment might reach a different conclusion but we don’t have one because the Department for Health, oddly, hasn’t carried out a formal health impact assessment of the policy it is trying to implement.

This is a depressing situation. The government has devoted considerable effort to producing a killer number: Jeremy Hunt’s “6,000 reasons” why he won’t let the British Medical Association stand in his way. It continues to produce statistical claims that spring up like hydra heads: when one claim is discredited, Hunt’s office simply asserts that another one can be found to take its place. Yet the government doesn’t seem to have bothered to gather the statistics that would actually answer the question of how the NHS could work better.

This is the real tragedy. It’s not that politicians spin things their way — of course they do. That is politics. It’s that politicians have grown so used to misusing numbers as weapons that they have forgotten that used properly, they are tools.

From: http://www.ft.com/cms/s/2/2e43b3e8-01c7-11e6-ac98-3c15a1aa2e62.html

Jeremy Hunt- lies bullshit and poisoned statistics

On the first day of the all out junior doctors strike Health Direct reposts a Financial Times review of Jeremy Hunt’s use of poisoned statistics.

On the first day of the all out junior doctors strike Health Direct reposts a Financial Times review of Jeremy Hunt's use of poisoned statisticsWe have more data — and the tools to analyse and share them — than ever before. So why is the truth so hard to pin down?

Thirty years ago, the Princeton philosopher Harry Frankfurt published an essay in an obscure academic journal, Raritan. The essay’s title was “On Bullshit”. (Much later, it was republished as a slim volume that became a bestseller.) Frankfurt was on a quest to understand the meaning of bullshit — what was it, how did it differ from lies, and why was there so much of it about?

Frankfurt concluded that the difference between the liar and the bullshitter was that the liar cared about the truth — cared so much that he wanted to obscure it — while the bullshitter did not. The bullshitter, said Frankfurt, was indifferent to whether the statements he uttered were true or not. “He just picks them out, or makes them up, to suit his purpose.”

Statistical bullshit is a special case of bullshit in general, and it appears to be on the rise. This is partly because social media — a natural vector for statements made purely for effect — are also on the rise. On Instagram and Twitter we like to share attention-grabbing graphics, surprising headlines and figures that resonate with how we already see the world. Unfortunately, very few claims are eye-catching, surprising or emotionally resonant because they are true and fair. Statistical bullshit spreads easily these days; all it takes is a click.

On July 16 2015, the UK health secretary Jeremy Hunt declared: “Around 6,000 people lose their lives every year because we do not have a proper seven-day service in hospitals.  You are 15 per cent more likely to die if you are admitted on a Sunday compared to being admitted on a Wednesday.”

This was a statistic with a purpose. Hunt wanted to change doctors’ contracts with the aim of getting more weekend work out of them, and bluntly declared that the doctors’ union, the British Medical Association, was out of touch and that he would not let it block his plans: “I can give them 6,000 reasons why.”

After negotiations between the Government and the British Medical Association lasting four years failed to reach a final agreement on February 11 2016 in London, Jeremy Hunt then announced in the House of Commons that new contracts would be imposed on Junior Doctors from August 1st 2016.

Despite bitter opposition and strike action from doctors, Hunt’s policy remained firm over the following months.

Yet the numbers he cited to support it did not.

In parliament in October, Hunt was sticking to the 15 per cent figure, but the 6,000 deaths had almost doubled: “According to an independent study conducted by the BMJ, there are 11,000 excess deaths because we do not staff our hospitals properly at weekends.”

Arithmetically, this was puzzling: how could the elevated risk of death stay the same but the number of deaths double? To add to the suspicions about Hunt’s mathematics, the editor in chief of the British Medical Journal, Fiona Godlee, promptly responded that the health secretary had publicly misrepresented the BMJ research.

Undaunted, the health secretary bounced back in January with the same policy and some fresh facts: “At the moment we have an NHS where if you have a stroke at the weekends, you’re 20 per cent more likely to die. That can’t be acceptable.”

All this is finely wrought bullshit — a series of ever-shifting claims that can be easily repeated but are difficult to unpick. As Hunt jumped from one form of words to another, he skipped lightly ahead of fact checkers as they tried to pin him down.

Full Fact concluded that Hunt’s statement about 11,000 excess deaths had been untrue, and asked him to correct the parliamentary record. His office responded with a spectacular piece of bullshit, saying (I paraphrase) that whether or not the claim about 11,000 excess deaths was true, similar claims could be made that were.

Part two is reproduced by Health Direct tomorrow: Jeremy Hunt- lies bullshit and poisoned statistics pt 2 .

Junior doctors threaten exodus after Hunt’s ultimatum

Junior doctors are threatening an exodus from the NHS after Health Secretary Jeremy Hunt imposed a new contract.

Junior doctors are threatening an exodus from the NHS after Health Secretary Jeremy Hunt imposed a new contract.After two strikes by junior doctors, the sticking point in negotiations remained the rates of pay for working Saturdays.

Under the new contract, 7am to 5pm on Saturdays will be regarded as a normal working day. But in a final concession, the Government offered a 30 per cent boost for any doctor working one or more Saturday a month.

Dr Johann Malawana, BMA junior doctor committee chairman said the union was now considering “all options open to us” warning of a “real risk that some will vote with their feet”.

This could mean further strikes – with an option of a full walkout by junior doctors, an attempt legal action by the union, or moves towards mass resignations.

On social media, junior doctors said they were considering emigrating, while others staged angry protests outside the Department of Health headquarters in Whitehall.

Labour accused Mr Hunt of “behaving like a recruiting agent for Australian hospitals” while the Labour Welsh health minister tried to lure medics over the border.

In a statement to the Commons, Mr Hunt said the BMA had proved “unwilling” to show flexibility and compromise.

He announced junior doctors would recieve a basic salary increase of 13.5 per cent – higher than the 11 per cent offered in November and insisted that no trainee working within contracted hours will have their pay cut.

The first new contracts would be imposed in August, on all new doctors graduating from medical school, and those changing contracts, during their training.

Some estimates suggest this means the majority of the 55,000 workforce would be on new contracts within a year.

Some doctors on longer contracts would not be affected, along with those who have completed their training, but not become a consultant.

In response, Dr Malawana had repeated the BMA’s offer of reducing basic pay in return for more unsociable hours payments.

Dr Malawana said: “The decision to impose a contract is a sign of total failure on the Government’s part.”

He accused Health Secretary Jeremy Hunt of “ploughing ahead with proposals that are fundamentally unfair” and warned that it had no plans just to accept the contract.

He said: “The Government’s shambolic handling of this process from start to finish has totally alienated a generation of junior doctors – the hospital doctors and GPs of the future, and there is a real risk that some will vote with their feet.

“Our message to the Government is clear – junior doctors cannot and will not accept a contract that is bad for the future of patient care, the profession and the NHS as a whole, and we will consider all options open to us.”

Health Direct echos BMA council chairman Mark Porter views: “Nurses and other clinical staff who work in the NHS will know now that essentially the Government is coming for them. If the Government is prepared to impose a contract on junior doctors, it’ll be them next.”

Cameron promises seven day health services

All hospitals in England will provide “a truly seven day NHS” health service under a future Conservative government.

Cameron promises seven day health servicesMr David Cameron said that more hospitals must provide top-level treatment at the weekend, starting with emergency care.

In a wide ranging speech, he said his party’s message to various sections of the population was: “We’re with you.” This spring forum is about fighting back against Labour on the NHS.

The Conservatives are committing to providing full weekend hospital care in England – in line with the NHS’s own five year plan.

This is an attempt to try to neutralise the NHS and enable the Conservatives to return to what they want to be talking about – the economy.

Speaking at the forum in Manchester, Mr Cameron warned that figures showed patients were “more likely to die” if they were admitted at weekends.

According to the Conservatives, official studies suggest mortality rates for those admitted on Saturdays and Sundays are 11% and 16% higher respectively than for those admitted on Wednesdays.

“For years it’s been too hard to access the NHS out of hours. But illness doesn’t respect working hours. Heart attacks, major accidents, babies – these things don’t just come from nine to five,” Mr Cameron said.

At weekends, he said, “some of the resources are not up and running. The key decision makers aren’t always there.

“With a future Conservative government, we would have a truly seven-day NHS. Already millions more people can see a GP seven days a week but by 2020 I want this for everyone, with hospitals properly staffed especially for urgent and emergency care, so that everyone will have access to the NHS services they need seven days a week by 2020 – the first country in the world to make this happen.”

The Liberal Democrats said NHS England already had plans to open hospitals and GP surgeries seven days a week, while UKIP said the Tories had “degenerated the NHS beyond all recognition” during the last five years in government.

The Conservatives have pledged to guarantee a real-term increase in funding for the NHS during the next Parliament, extending the ring-fence in place for the past five years. Labour has said it will spend £2.5bn more than its opponents.

Health Secretary Jeremy Hunt said government reforms of the NHS were saving £1.5bn a year but that the NHS “will need more money”.

He added that the NHS’s own sums suggested the predicted £30bn annual shortfall could be “reduced with efficiency changes, and we’re backing that plan”.

New clinical standards set out in 2013 require hospitals to provide seven-day access to diagnostic tests, such as X-rays, ultrasound, MRI scans and pathology, as well as providing access to multi-disciplinary teams, which include expert nurses and physiotherapists.

In its blueprint for services over the next five years, published last October, NHS England said hospital patients should have access to seven day services by 2020. “

Osborne gives NHS £2 billion for extra winter funds

George Osborne has announced that he will add an extra £2 billion into the NHS in his Autmn Statement this week.

Osborne gives NHS £2 billion for extra winter fundsThe chancellor said it was not a “one off” but what he called a “down payment on a long term NHS plan”. There would be no “unfunded giveaways”, he said, adding he could make the pledge because the economy was strong.

Mr Osborne’s pledge – to be officially announced in his Autumn Statement on Wednesday – comes after NHS bosses warned of a need for an extra £2 billion funding, to cope with the immediate, unprecedented pressure on NHS budgets.

The chancellor told BBC One’s Andrew Marr Show “Because we have a strong economy and we’ve got the public finances under control, we can afford to put £2 billion into the frontline of the NHS across the United Kingdom.

“I can tell you we can go further and use those fines that have been paid by the banks for a permanent improvement in GP services. This is a down-payment on the NHS’s own long-term plan and it shows you can have a strong NHS if you have a strong economy.”

Further details are expected on Wednesday when Mr Osborne will update Parliament on his tax and spending plans, based on the latest predictions for the economy.

He rejected claims public services would suffer if funding was cut further and said he would outline how the UK would “stay the course to prosperity”.

“We shouldn’t face this false choice of either bankrupting the country or having decent public services,” he said.

But he added that “difficult decisions” might lie ahead on welfare – possibly freezing working age benefits, although he appeared to rule out cuts to pensioners’ benefits.

Health Secretary Jeremy Hunt will make a statement on Monday, in which he is expected to explain where the money is coming from.

About £1.3 billion is thought to be new money, from savings in other departments, while around £700 million will come from non-NHS parts of the Department of Health’s budget.

It is understood that around £1.7 billion of that will go to NHS England, with the remainder going to the rest of the UK.
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For months, NHS leaders have been warning politicians about a growing shortfall in their budget. Today the message from the chancellor was that he’s heard their call.

The Liberal Democrats are keen to take credit, saying they’ve fought hard to secure it. Labour say they want to go further and have pledged £2.5 billion a year to be spent on the NHS, on top of today’s announcements, paid for by a so-called mansion tax and other tax crackdowns.

NHS funding is going to be one of the key battlegrounds ahead of the next election but with figures due out this week expected to confirm that government borrowing is not coming down in line with the Treasury’s plans, all parties will face tough questions about how they can increase spending without increasing borrowing yet further.
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Mr Hunt will also announce that the government is committed to implementing a five-year plan – NHS Forward View – unveiled by six national bodies last month. Many of the measures put forward are designed to curb the rise in hospital admissions and the impact of the ageing population.

The plans involve increasing spending on the health service by £8 billion in real terms over the next Parliament.

The NHS is a huge political issue with all the main parties pledging extra money in the future.

Obesity and diabetes drugs cost needlessly harms NHS

NHS Scotland has spent nearly £230 million on drugs to treat diabetes and obesity within the last three years figures have shown.

Obesity and diabetes drugs cost needlessly harms NHSThe diabetes drugs bill was £75.7 million in 2013-14, £73.2 million last year and £74.2 milion in 2011-12.  Another £6.1 million went on obesity prescriptions in the three year period.

The figures were obtained by the Conservatives who said the conditions were harming both sufferers and the NHS.

The Scottish government said obesity and diabetes were on the rise across Europe and Scotland was no exception. It said the problem was being taken seriously and a range of measures had been implemented to try to tackle it.

The most recent statistics suggested nearly a quarter of a million people in Scotland now have diabetes, almost 5% of the population. The majority of sufferers, about 220,000, have type 2 diabetes.

A total of 3.34 million items were dispensed to treat diabetes in Scotland in 2013-14.

The official figures revealed that obese patients were prescribed more than 52,000 items in the same period – about 1,000 a week – at a cost of £1.9 million.

That is up from the cost of £1.5 million in 2012-13, but lower than the previous year, when £2.7 million was spent on obesity prescriptions.

Conservative health spokesman, Jackson Carlaw, who obtained the figures, said: “Of course, not every case of diabetes is related to weight, there are a range of reasons. But the fact prescriptions for both diabetes and obesity are rising at an alarming rate year-on-year cannot be ignored.”

“While we need the NHS and Scottish government to do all they can to force through messages on healthy living, it isn’t just down to them.  There has to be a level of personal responsibility.”

“Obesity generally isn’t something you catch on a bus, and people know that a healthy diet and active lifestyle are what’s required to keep the weight down.  If they don’t, diabetes is just one of the serious conditions lurking round the corner.”

A Scottish government spokesman said: “Our diabetes action plan, which will be updated this summer, sets out a clear commitment to the prevention and early detection of diabetes and to improve the treatment and care of people with diabetes.

“Although the number of people with Type 2 diabetes has increased in the last year, the number of prescriptions per person has remained at the same level.

“We are supporting child healthy weight interventions and are increasing opportunities for children to get involved in sport and physical activity, through active schools and our target of all primary children having two hours of PE lessons a week.”

Direct Health NHS 111 debacle- inquiry needed

An independent inquiry is needed into the direct health NHS non-emergency 111 phone line “debacle” in England GPs say.
Direct Health NHS 111 debacle- inquiry neededDoctors at the British Medical Association’s GPs conference in London said lessons had to be learned after the “disastrous” roll-out of the service in recent months.

The phone line – which has replaced NHS Direct – has been dogged by reports of calls going unanswered and poor advice.

GPs said they had seen their workloads increase because of the problems.

There are actually 46 different services across the country, run by a variety of organisations including private firms and ambulance crews.

Some places have seen the service suspended, while others are relying on the support of old NHS Direct teams to deal with calls.

GPs at the conference in London voted unanimously in favour of a motion calling for an independent inquiry over debacle.

John Hughes, a GP from Manchester, which saw its 111 system suspended soon after its launch, said the whole system was an “absolute mess”.  He said he had been told on the night it crashed in the north west the service had just 31 call handlers instead of the 100 GPs had been told it would.

Others complained they had been deluged with paperwork from 111 and visits from confused patients who had not got the right advice from the phone line.

South London GP Lilian Awere said: “It has been successful in some places, but in most places it has been disastrous.  The workload in A&E and for GPs has increased.”

NHS England has admitted the failings have been “inadequate”, but has said the service is now improving. It is carrying out its own review into what went wrong.

The call comes as the BMA’s GP chairman Dr Laurence Buckman launched an attack on Health Secretary Jeremy Hunt.

He accused Mr Hunt of being more interested in bashing doctors and spouting “rubbish” after the health secretary blamed the rise in A&E waits on changes to the GP contract in 2004 which allowed GPs to stop providing out-of-hours care.

Dr Buckman said there was no evidence that the changes, which led to agencies taking on responsibility for care, have been a major factor.