How NHS 24 and Elsevier are turning uncertainty into confident, clinically safe decisions
by Molly Malone and Ian Evans
A parent calls late at night about a child whose symptoms need careful assessment. Another caller with discomfort, dizziness, breathlessness or anxiety, tries to describe what is happening while they are still in the middle of it.
In these moments, NHS 24 clinicians and call handlers are dedicated to assessing symptoms, identifying risk, and guiding people to the right care.
NHS 24’s role is to turn that uncertainty into a safe next step, helping people make informed decisions quickly, consistently and with confidence.
It's a challenge increasingly familiar across healthcare, research and innovation. Professionals are expected to act faster while navigating growing complexity, rising information volume and higher expectations around trust and accountability.
That is where trusted knowledge, AI-supported reasoning and expert assessment work together. Across Scotland, the 111 Unscheduled Care service handles around two million calls a year to triage people who think they need urgent healthcare at nights and weekends, and for A&E/MIU. Each interaction supports clinical decision-making, helping determine whether a caller is best supported through an out-of-hours GP, mental health services, A&E or emergency response, a visit to a community pharmacy or self-care advice.
This work is underpinned by clinically validated pathways and decision support tools that enable staff to navigate complex conversations, triage effectively, and provide clear, safe next steps.
By combining clinical expertise with reliable technology, NHS 24 ensures that every caller is directed to the right service, at the right time, in a way that supports safe and effective care.
Rebuilding the digital foundations of Scotland’s 111 service
As part of a major transformation to improve care, NHS 24 chose Elsevier’s cloud-based Clinical Reasoning Engine (CRE) as the clinical reasoning foundation for its next-generation 111 service.
Ann-Marie Gallacher, Chief Information Officer of NHS 24, describes it as central to the new estate.
“It is the jewel in the crown of our application estate,” she says. “There’s the brains within it all.”
In a constrained public health environment, that place had to be earned. NHS 24 needed a strong case for the investment, grounded in clinical value, operational value and confidence in delivery.
Gallacher saw a clear answer. “What Elsevier has built isn’t a straightforward decision support tool. It’s a reasoning engine.”
“What Elsevier has built isn’t a straightforward decision support tool. It’s a reasoning engine.”
Ann-Marie Gallacher
Chief Information Officer, NHS 24
Across Scotland, the 111 Unscheduled Care service handles around two million calls a year to triage people who think they need urgent healthcare at nights and weekends, and for A&E/MIU. Each interaction supports clinical decision-making, helping determine whether a caller is best supported through an out-of-hours GP, mental health services, A&E or emergency response, a visit to a community pharmacy or self-care advice.
This work is underpinned by clinically validated pathways and decision support tools that enable staff to navigate complex conversations, triage effectively, and provide clear, safe next steps.
By combining clinical expertise with reliable technology, NHS 24 ensures that every caller is directed to the right service, at the right time, in a way that supports safe and effective care.
“What Elsevier has built isn’t a straightforward decision support tool. It’s a reasoning engine.”
Ann-Marie Gallacher
Chief Information Officer, NHS 24
As part of a major transformation to improve care, NHS 24 chose Elsevier’s cloud-based Clinical Reasoning Engine (CRE) as the clinical reasoning foundation for its next-generation 111 service.
Ann-Marie Gallacher, Chief Information Officer of NHS 24, describes it as central to the new estate.
“It is the jewel in the crown of our application estate,” she says. “There’s the brains within it all.”
In a constrained public health environment, that place had to be earned. NHS 24 needed a strong case for the investment, grounded in clinical value, operational value and confidence in delivery.
Gallacher saw a clear answer. “What Elsevier has built isn’t a straightforward decision support tool. It’s a reasoning engine.”
From symptom trees to a single patient journey
“The patient gets to the endpoint far more quickly, which is what everybody needs.”
Ann-Marie Gallacher, Chief Information Officer, NHS 24
Patients rarely call with tidy, single-symptom problems. They describe overlapping concerns, in their own words.
Elsevier’s Clinical Reasoning Engine helps NHS 24 staff assess those factors together through clinically governed pathways, guiding them to the appropriate endpoint — from self-care or pharmacy advice to out-of-hours GP, mental health support, A&E or emergency escalation.
“It allows us to take in a number of factors to get to the endpoint for the patient and for the staff delivering the service very quickly,” Gallacher says. “The patient gets to the endpoint far more quickly, which is what everybody needs.”
Jörn Felten, VP Business Development & Global Partnerships, Global Clinical Solutions, Elsevier, views this as the engine’s core strength: helping NHS 24 manage around 300 symptom categories within one coherent patient journey.
From symptom trees to a single patient journey
“The patient gets to the endpoint far more quickly, which is what everybody needs.”
Ann-Marie Gallacher, Chief Information Officer, NHS 24
Patients rarely call with tidy, single-symptom problems. They describe overlapping concerns, in their own words.
Elsevier’s Clinical Reasoning Engine helps NHS 24 staff assess those factors together through clinically governed pathways, guiding them to the appropriate endpoint — from self-care or pharmacy advice to out-of-hours GP, mental health support, A&E or emergency escalation.
“It allows us to take in a number of factors to get to the endpoint for the patient and for the staff delivering the service very quickly,” Gallacher says. “The patient gets to the endpoint far more quickly, which is what everybody needs.”
Jörn Felten, VP Business Development & Global Partnerships, Global Clinical Solutions, Elsevier, views this as the engine’s core strength: helping NHS 24 manage around 300 symptom categories within one coherent patient journey.
Clinical governance at the centre of safe scale
For NHS 24, safe scale depends on rigorous clinical governance and on technology staff can trust to support clinically safe decisions.
CRE was put through the same scrutiny NHS 24 applies to front-line care: engine outputs compared with clinician results across the same pathways, pathways reviewed by the medical director, nursing colleagues and clinical teams, and risks examined before the system went live.
“There isn’t a nook or cranny that’s not been poked and tested and pulled apart,” Gallacher says.
That process is what builds confidence. In remote assessment, staff need to trust the pathway in front of them, rely on it to guide safe decisions and recognize when to escalate.
“We never put anything that’s not clinically safe in the front line,” she says.
With that governance in place, NHS 24 can use its workforce differently. Trained care providers can support patients safely within defined pathways, supported by a system they trust, while clinicians focus on the cases that need their judgement most.
“It allows us to deliver more services more quickly without the delay of waiting for a clinical assessment when the output is clinically safe,” Gallacher says. “It’s a very powerful thing.”
“It allows us to deliver more services more quickly without the delay of waiting for a clinical assessment when the output is clinically safe. It’s a very powerful thing.”
Ann-Marie Gallacher
Chief Information Officer, NHS 24
“It allows us to deliver more services more quickly without the delay of waiting for a clinical assessment when the output is clinically safe. It’s a very powerful thing.”
Ann-Marie Gallacher
Chief Information Officer, NHS 24
For NHS 24, safe scale depends on rigorous clinical governance and on technology staff can trust to support clinically safe decisions.
CRE was put through the same scrutiny NHS 24 applies to front-line care: engine outputs compared with clinician results across the same pathways, pathways reviewed by the medical director, nursing colleagues and clinical teams, and risks examined before the system went live.
“There isn’t a nook or cranny that’s not been poked and tested and pulled apart,” Gallacher says.
That process is what builds confidence. In remote assessment, staff need to trust the pathway in front of them, rely on it to guide safe decisions and recognize when to escalate.
“We never put anything that’s not clinically safe in the front line,” she says.
With that governance in place, NHS 24 can use its workforce differently. Trained care providers can support patients safely within defined pathways, supported by a system they trust, while clinicians focus on the cases that need their judgement most.
“It allows us to deliver more services more quickly without the delay of waiting for a clinical assessment when the output is clinically safe,” Gallacher says. “It’s a very powerful thing.”
More time listening, less time navigating the screen
The impact is already being felt by staff.
Lucy Hartley, Communications Manager at NHS 24 says early feedback from call handlers has been clear: the new system feels more intuitive.
“I can spend more time listening to the patient and less time focused on the screen,” one staff member reported.
Clinicians and care teams are already time-burdened, and the ability to act quickly with confidence can shape the patient’s next step.
While staff listen to the patient, the engine structures the reasoning. Rather than replacing professional judgement, the system helps structure complex information so staff can focus on the conversation, the context and the decision itself.
Gallacher links that to efficiency and experience.
“It’s faster for the patient,” she says. “And it’s easier for our call handler and our non-clinicians.”
Delivering through integration pressure
The implementation carried real pressure. NHS 24 was replacing a broad set of systems, moving away from expensive legacy arrangements and coordinating multiple partners.
Gallacher describes the period candidly.
“Even when we had big issues trying to go live and with our integrations, everybody worked together as one team,” she says. “We got through on time. We delivered everything we needed to do on time and on budget.”
In a national urgent care service, a delayed or unstable migration creates operational risk. Elsevier’s role was to keep its milestones, support integration and help NHS 24 protect continuity during a complex transformation.
For Elsevier, the work also brought home the human importance of NHS 24’s service. During a visit to Glasgow, Felten recalls speaking with a taxi driver whose family had used the service after a difficult health episode at home.
The conversation stayed with him: every patient interaction matters, and when a service like this works well, it can save lives.
Extending clinical reasoning beyond the call centre
NHS 24 and Elsevier are already looking at what comes next.
Gallacher describes the partnership as being at “Base Camp,” with more value to come through optimization and innovation. One immediate opportunity under discussion is the patient portal: using the same reasoning engine and clinical content online as well as in the call centre.
That could allow people to begin triage digitally, move smoothly into a follow-up call where needed and avoid repeating information. For NHS 24, it points toward one trusted content set supporting more patient journeys.
The foundation is now in place for NHS 24 to scale trusted clinical reasoning across more patient journeys and channels.
More broadly, the partnership reflects a growing need across healthcare, research and innovation: helping professionals move faster through complexity without losing confidence in the evidence, reasoning and expertise behind the decision.
By combining trusted knowledge, AI-supported reasoning and expert assessment, Elsevier is helping organizations turn uncertainty into clearer next steps.
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