Transforming Urgent Care Services

Implementation of NHS 111 in

Portsmouth, Southampton and Hampshire

NHS 111 – National Context• Pilots for the 111 service began in 2010• NHS 111 will need to be available

nationwide by April 2013• In some areas the 111 service is being

introduced as a pilot• In Southampton, Hampshire and

Portsmouth we have proceeded direct to procurement

• Operational here in phases from Autumn 2012 – fully operational by April 2013

NHS 111 – National Context

• NHS 111 aims to make it easier for people to access healthcare services when they need medical help fast, but it’s not a life-threatening situation.

• In future if people need to contact the NHS for urgent care there will only be three numbers: 999 for life-threatening emergencies; their GP surgery; or 111.

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Our area

• SHIP PCT Cluster (Southampton, Hampshire, Isle of Wight and Portsmouth)

• Isle of Wight running a separate pilot project

• Combined allocation of £2.9 billion• Supporting GP Clinical Commissioning

Groups for nearly 1.6 million people in 3 local authority areas

• 4 health systems

Unscheduled Care is unsustainable

• 37% of visits to A&E can be dealt with without A&E intervention

• 29% of calls to ambulance services are Category C• Inefficient - duplication of triaging and call handling in

both non-emergency and emergency care • Impossibly complex system for patients to understand

– and for health professionals!• SHIP Unscheduled Care Strategy

– http://www.hampshire.nhs.uk/create-content/upload-files/doc_details/1407-com11-009-ship-unscheduled-care-strategy

NHS 111 an enabler

• NHS 111 a critical service for the health system:

• Right care, right place, right time:

• Patients more likely to get a condition-specific service

• Channel patients towards new appropriate services – skipping the awareness phase

• Can ‘load balance’ amongst urgent care services, reducing underused capacity and being more joined up during heavy usage periods

• Provide patients with long term conditions advice when their typical sources of support are unavailable

• Provide care in line with patients’ agreed care pathways

Local principles for 111 Service

• Local service provided from within the county• Effective and patient-centred approach• Using NHS Pathways – recognised diagnostic

system designed by doctors• Advice and guidance from a Directory of

Services created by local clinical staff and updated on an almost real-time basis

• Directory of Services focused around Clinical Commissioning Group areas

Objectives for 111 service

• Creation of a simpler more efficient unscheduled care system

• Patients receiving care from the right person, at the right time, in the right place

• Create a common point of access for the unscheduled care systems in SHIP Cluster

• Ensure best use of services and minimise inappropriate use of higher cost service settings

• Create a system that can manage demand dynamically

• Use management information from the system to ensure efficient service delivery and, where appropriate, decommission services that are not required

The NHS 111 service concept

Trained call handlers answer calls, performing an initial assessment with decision support software such as NHS Pathways

When required, callers will be warm transferred to a clinician

A DoS for each clinical commissioner provides call handlers with the information they need to refer patients. Call handlers’ assessments of clinical needs will be accepted without reassessment by services.

The DoS will have real-time capacity management information for A&E and 999/ambulance services, with other services to be brought on line

Call handlers can dispatch ambulances without reassessment

Call Handling

Directory of Services (DoS)

Programme plan

• Service specification development Sept 2011 – Jan 2012

• Development of Directory of Service (DOS) Nov 2011 – Apr 2012

• Tendering process Jan 2012 – Apr 2012

• Contract awarded June 2012

• Publicity period August 2012 – Dec 2012

• Soft launch – wave one Oct 2012

• Public go-live Nov 2012

• Implementation period Oct 2012 – Mar 2013

Public Information

• NHS 111 is a new FREE telephone number

• You should call it when you need medical help fast but you don’t need an ambulance

• It will be easier and faster to get advice or medical treatment, when you cannot wait for an appointment to see your doctor

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How does it work?

• For general health information and advice• To ask where the nearest health services are, like

a pharmacy or dentist• If you don’t know if you need 999 or A&E

(Accident and Emergency)• When your doctor’s surgery is closed• If you don’t know how ill you are• For advice on how to look after yourself at home

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• You will speak to an adviser from the NHS 111 team• An adviser is someone who has been trained to give

you medical advice and help, they may be a nurse• They will ask you questions to find out what help you

need• • The 111 adviser will be able to:

• – Decide what medical help you need• – Tell you where to go to get this medical help• – Transfer your call to the service you need or book an

appointment for you, if possible.

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Why is NHS111 being introduced?

• Some people don’t know where they should turn to for medical help quickly.

• They call 999 or go to A&E.• 999 and A&E should only be used for

emergencies.• 111 will make sure patients go to the right

place.

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How are we going to tell people about NHS111?

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• Posters• Leaflets• Radio• A leaflet through the door• Websites & Facebook• Newspapers and Magazines• Events• Leaflets in different languages• Easy-read booklet

Who will provide the NHS111 service for residents in Hampshire, Southampton and Portsmouth?

• South Central Ambulance Service will provide the service for our residents

• The service will run alongside the 999 service

• Based at Otterbourne near Winchester and Eastleigh

• Public will be able to call NHS111 from November 2012

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NHS Pathways for Primary Care and Ambulance Services

NHS Pathways

Urgent and Emergency Care:Integrated Access

111

Dispositions –skill set & timeframe

• 999 Emergency Department• See/Contact GP/Primary Care• Speak to GP/Primary care• Dentist/Pharmacy/Midwife etc• Home Care

• Operational eg. Repeat prescriptions

• An evidence based set of UK clinical triage content that is constantly updated and refined

• Freedom from commercial exploitation of the NHS in clinical content development

• Advanced accreditation, training and reporting capabilities• Local delivery of national standards• An integrated process of telephone access to urgent and

emergency care

The Prize….Taking healthcare to the patient: Transforming NHS ambulance services, DH 2005Urgent Care, RCGP position statement, 2007Guidance And Competences For The Provision Of Services Using Practitioners With Special Interests RCGP, 2008

Your questions?