What is NHS 111?
NHS 111 is a Department of Health developed vision of a Single Point of Access for urgent care. Callers will be triaged using a clinical call handling system and signposted to a local service. It will be available 24 hours a day, seven days a week, 365 days a year. In future if people need urgent care there will only be three numbers; 999 for life-threatening emergencies; their GP surgery; or 111.
What are the expected benefits?
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Improved patient and carer experience by providing clear, easy access to more integrated services
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Improved efficiency of the urgent and emergency health care system by connecting patients to the right place, first time
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Increased public confidence in the NHS and enhancing the reputation of the NHS
When will it be rolled out?
It is intended that NHS 111 is rolled out across the country by 2013.
The North West region (NHS North West), submitted a regional bid to be a second wave pilot. This was approved and it has been agreed that Cumbria and Lancashire will take the lead.
What are the timescales?
The pilot is currently planned to launch in the autumn, subject to thorough testing and a clinical governance review undertaken by the DH. If the service isn’t ready to be launched, it won’t be.
What will be the impact on my practice?
There has been significant comment in relation to the impact on GP practices and the report that 60% of calls result in primary care dispositions. Around 60% of calls do result in a primary care disposition however this is broken down into the end dispositions above and many more, such as: see a Dentist, contact Pharmacist, self-care advice, medication enquiry, speak to a nurse (NHS 111 nurse adviser).
To provide further assurance, taking a single day in June in Nottingham City and Lincolnshire (28th June 2011), with a population of about a million patients, only 34 patients were referred to in hours GPs, across about 170 GP practices.
NHS Pathways, the clinical call handling system – is it safe and how will the service affect my practice?
NHS Pathways is an NHS developed and owned system within Connecting for Health. The system provides a generic clinical decision support system for the assessment of urgent care. It is supported by the BMA and all the Royal Colleges. A National Clinical Governance Group chaired by the Royal College of General Practitioners (RCGP), who oversee the clinical changes upgrades required following NICE/Royal College guidance.
The system has been robustly tested and has taken over 1.9 million calls across four pilot sites. It has been used by the North East ambulance service since 2006.
Further information can be obtained from:
http://www.connectingforhealth.nhs.uk/systemsandservices/pathways/about/how/index_html/?searchterm=nhs%20pathways
http://www.connectingforhealth.nhs.uk/systemsandservices/pathways/faqs/index_html/?searchterm=nhs%20pathways
NHS Pathways clinically assesses the patient via telephone triage, based on the symptoms they report when they call. Structured symptom based flows determine the clinical skills required, and the timeframe in which they must be accessed. The system returns a ‘disposition’ which defines which clinical service can best meet the patients need.
NHS Pathways does not diagnose illnesses. It uses the presence and features of symptoms to progressively exclude conditions during the phone assessment and directs the caller to the most appropriate service.
There are eleven GP dispositions in NHS Pathways, these are broken down as follows:
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To be seen by GP Practice within 2 hours
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To be seen by GP Practice within 6 hours
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To be seen by GP Practice within 12 hours
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To be seen by GP Practice within 24 hours
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For persistent or recurrent symptoms: get in touch with the GP Practice within 3 working days
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For persistent or recurrent symptoms: get in touch with the GP Practice within 2 weeks
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Speak to GP Practice within 1 hour
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Speak to GP Practice within 2 hours
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Speak to GP Practice within 6 hours
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Speak to GP Practice within 12 hours
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Speak to GP Practice within 24 hours
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How should the practice deal with patients contacting the surgery, following assessment via 111?
NHS Pathways reaches a disposition that states where a patient should go, and within what timeframe for it to be clinically safe. If a patient presents to your surgery saying that they have called 111 and were advised to ring their surgery, it is recommended that they are asked what they were told and then see them or speak to them within that timeframe. It should be noted that, from the evidence in the first wave of pilots, only a handful of patients a day need to see or speak to a GP within normal practice hours.
The practice should manage unscheduled care as they do so already via practice protocols/clinical triage where available. Many practices have good systems in place to manage patient demand. However practices may wish to revisit their current systems and review in line with the NHS 111 the GP dispositions outlined above. The following document provides some good examples of the management of unscheduled care demand in practice.
http://www.primarycarefoundation.co.uk/images/PrimaryCareFoundation/Downloading_
Reports/Reports_and_Articles/Urgent_Care_Centres/Urgent_Care_May_09.pdf
Will we have to offer direct booking from 111?
As a GP operating within normal surgery hours, no. The NHS 111 service is required to have the ability to book appointments for patients where appropriate. If a caller is assessed as needing to be seen by an out of hours GP the NHS 111 call adviser should, where possible, be able to book them an appointment, or should transfer the patient through to a booking agent at the OOH provider to avoid the need for a ring-back.
There is no intention of NHS 111 replacing in-hours booking of GP appointments. However if local GP Clinical Commissioning Groups want to offer this, this can build this into the local service specification.
If a caller requires in-hours GP services they will be advised to contact their GP directly. Unless an individual GP practice expresses a strong interest in trialling appointment booking, there will be no booking of in hours GP appointments through NHS 111.If their GP is unavailable within the suggested timeframe, the patient should be advised to call NHS 111 again to find an alternative service to meet their needs.
What about our Out of Hours message/divert?
It is recommended GP practices advise patients to hang up and redial 111, as this is free to the caller from all land lines and mobiles. However, you are advised to make no changes to your local message until a communication is sent from the Care Trust Plus advising you to do so. A communication will be forwarded to the practice to make the change at the appropriate time within the pilot go live timetable.
How will 111 stop people trying to jump the queue in GP practice waiting lists? When a patient calls NHS 111 they will be triaged. If the patient needs to see a GP during normal practice hours they will be advised to call their GP to make an appointment. Unless individual GP practices express a strong interest in trialling appointment booking, there will be no booking of in hours GP appointments through NHS 111.
To read a testimonial from GP Dr Tom McKenzie about his visit to the test site click here……
