NHS 111 vs 999: when to call which

The two numbers sit on a simple dividing line. NHS 999 is for life-threatening emergencies. NHS 111 is for situations where you need help from the NHS urgently but you do not think your life is at immediate risk, or where you cannot tell how serious something is.

The NHS describes 999 as being for emergencies such as serious road traffic accidents, strokes and heart attacks. In its description of 111, it says the service can help if you think you need medical help right now, and that it can direct you to the best place to get help if you cannot reach your GP during the day or your GP is closed. If you are unsure which applies, the NHS tells you to start with 111, because 111 can check your symptoms and tell you what to do. Anyone who has signs of a life-threatening illness, or has tried to end their life, should call 999 straight away, according to the NHS 111 page.

The same logic applies if you start with 111 and your situation changes. The NHS 111 page tells people waiting for a callback that if symptoms get worse and they have signs of a life-threatening illness, they should call 999 now.

The table below sets the services side by side, using what the NHS says on its urgent and emergency care pages.

The NHS pages on specific conditions give concrete examples of the emergency threshold. These are worth knowing before you need them, because in a real emergency it is hard to think clearly.

For a suspected heart attack, the NHS says to call 999 if you have chest pain that feels tight or like squeezing, chest pain that spreads to your arms, neck or jaw, severe difficulty breathing (gasping, choking or unable to get words out), lips or skin that are pale, blue or grey, or if someone has passed out and is not responding normally. While waiting, the NHS advises sitting and resting in a comfortable position, taking aspirin (300mg) if you have any and are not allergic, and using your GTN spray if you have angina.

For a suspected stroke, the NHS says to call 999 now if you think you are having or have had a stroke, or if you have had signs of a stroke within the last 24 hours even if they have stopped. The signs it lists as FAST are face weakness, arm weakness, speech problems and time to call 999. The NHS adds that stroke symptoms can sometimes stop after a short time, so you may think you are fine, but you should still get medical help straight away.

The NHS also says a suddenly confused person, someone bleeding non-stop, and anyone who has seriously harmed themselves, for example by an overdose, needs a 999 call or A&E.

• Signs of a heart attack: tight or squeezing chest pain, pain spreading to arms, neck or jaw, severe breathlessness, pale, blue or grey skin.

• Signs of a stroke: face drooping, arm weakness, slurred or confused speech, even if they pass.

• Someone who has passed out and is not responding normally.

• Severe or non-stop bleeding, or sudden confusion.

• Someone who has tried to end their life or seriously harmed themselves.

The NHS lists a series of situations where 111 is the right route. These include needing medical help right now when it is not an emergency, not knowing where to go, being unable to contact your GP, or needing help out of hours.

Depending on what you need, 111 may point you to an urgent treatment centre, an evening or weekend GP, a nurse callback, urgent specialist support for dental or mental health problems, your own GP surgery, a pharmacist for a minor illness, or advice to look after yourself safely at home. It can also arrange an emergency supply of regular medicine: the NHS says 111 online does not issue a prescription but sends a request to a local pharmacy for a limited supply until you can organise your repeat prescription.

There are some limits. The NHS says 111 online cannot issue fit notes, which you need to get from your GP, and cannot make or cancel appointments for you in other parts of the NHS.

The NHS recommends calling rather than using 111 online if you need help for a child under 5, have complex problems caused by an existing medical condition, have a care plan from your doctor for your current problem, or need end-of-life care.

When you call 999, the NHS says the call handler will ask for the location of the emergency (a postcode or landmarks help), what has happened, and a contact number in case they need to call back. They will tell you when they have all the information they need. If you are told a callback will happen, make sure someone is there to answer.

Help may arrive in an emergency ambulance, a rapid response vehicle or motorbike, a paramedic's own car, a cycle response unit, or a mixture. You might be given instructions, including basic first aid, while you wait. The NHS suggests staying with the person, switching on lights in a dark house, using hazard lights if you are in a car, calling 999 again if the person's condition or your location changes, locking away pets, and writing down the person's GP details and gathering their medicines and allergy information if you can.

With 111, the NHS says that depending on your symptoms you may be offered a callback from a nurse. You cannot request one. The wait depends on the symptoms you reported, and people with the most serious symptoms are called back first. A nurse will try up to 3 times and, if they cannot reach you, will leave a message; you would then need to start again. You cannot cancel the call because a nurse needs to check you are okay, but you can tell them if you feel better or have found help elsewhere. The NHS says you do not need to contact 111 again while you are in the queue unless your symptoms have changed or got worse.

A&E is described by the NHS as being for serious injuries and life-threatening emergencies. It is open 24 hours a day, every day. Arriving by ambulance does not always mean you will be seen sooner, because everyone is assessed by triage so the most seriously unwell people are seen first. The NHS asks people not to drive themselves and to bring any medicines they take.

If you have used 111 and the hospital knows you are coming, you will not need to use the self-assessment tool that some A&E departments have at the front door. People who do not need A&E may be sent to a nearby urgent treatment centre or a GP on site.

Where you live changes the details. The NHS 111 page notes that in Scotland the equivalent is NHS 24 111, in Wales NHS 111 Wales, and in Northern Ireland nidirect provides advice about illnesses and conditions.

It is understandable to hesitate before calling 999 for fear of wasting time. The practical guidance from the NHS is that if you are not sure, you should use 111 online or call 111. If the situation looks life-threatening, or the person is unresponsive, not breathing normally or showing the emergency signs above, do not wait for a callback: call 999.

The NHS 999 page suggests having the person's GP details, medicines and any allergies to hand for the paramedics, so it can help to know where these are kept before you need them.