NHS 111 & GP Out-of-Hours Dr David Davies Clinical Lead - - PowerPoint PPT Presentation

Islington CCG

NHS 111 & GP Out-of-Hours

Dr David Davies Clinical Lead

Introduction

Focus:

• Procurement of a combined NHS 111/Out of Hours (OOH) service,

with other North Central London CCGs, by April 2016 What we will cover:

• Context – our urgent care review
• Explain the clinical model for NHS 111 and out of hours services
• Plans for re-procurement of NHS 111 and GP out of hours services
• An update on the engagement we are undertaking
• Next steps

Local Context

• 2010: GP OOH delivered to C&I by Harmoni
• 2012, November: Care UK take over from Harmoni

providing OOH Service

• 2013, April: LCW (not for profit) commence contract to

provide 111 for C&I

• 2013, October: Primary Care Foundation review of

Harmoni/Care UK Out of Hours Service. The review found the service was clinically safe and provided good care.

• 2014, March: Urgent Care Review Camden and Islington

Urgent Care Review: Community engagement

• Engagement August to November 2013
• Through media and advertising; online survey; audit day;

workshops with community groups People wanted:

• Smooth and efficient links between NHS111 and OOH
• A service that is easy to use and accessible
• Staff operating NHS 111 have the right knowledge and skills
• Easy referral into the necessary services
• Everyone in the community will find the service easy to use
• More local knowledge of NHS 111 and OOHs.

Urgent Care Review: Conclusions

Requires High quality, safe care, 24/7, right care, right place, first time Easy to navigate and understand with equity of access A smooth patient pathway, with minimum number of organisations, repeated information gathering and handovers. Recommends Commission 111 across all of NCL Combined NHS 111, GP Out of Hours (OOH) service as a single whole system model (though not necessarily a single provider)

The 111 patient journey in London

GP GP

ANSWER APPROPRIATE CARE ASSESSMENT

London directory of local skills and services (DoS) Contains information for a wide range of organisations in a locality, including

• pening hours, referral criteria, and real-time capacity

999 A&E UCC GP in hours GP OOH NHS Direct Midwife Mental Health crisis services Pharmacy Rapid response nursing Palliative care services, hospices

ACCESS

NHS Pathways Consistent assessment of clinical needs NHS 111 call advisers NHS 111 call advisers Locally commissioned call handling Integration with pan-London ‘Co-ordinate my Care’ (CMC) Register for end-of-life care

111, OOH and LAS data Nov 13-Dec14

• Population of 218,000 (JSNA 2014)
• If every patient has four GP appointments per year, this amounts to

approximately 880,000 appointments.

• Circa 25,000 calls to NHS 111:
• Circa 18,000 calls to GP out of hours services
• Circa 22,000 attendances at UCLH Emergency Department
• Circa 35,000 attendances at Whittington Emergency Department

Re-procurement features

• Procurement is legally required by NHS England, current

contracts end March 2016

• All the 5 NCL Boroughs, and across London

re-procurement is being undertaken

• It requires community engagement, not consultation
• GP out of hours services providing telephone

assessments, face to face visits, and home visits.

Re-procurement features re 111

• It is a national requirement for all CCGs
• We aim that it will be across five boroughs, as now
• It will be an integrated service

– this does not necessarily mean a single provider for both services, partnership bids are encouraged

• NHS 111 is a nationally mandated model, but we will

adapt as much as we can to fit local need.

What’s possible?

• One governance structure
• Improved pathways for patients (avoiding patients

repeating information)

• Prescriptions available far earlier when a person calls.
• Quicker access to specialist help for dental problems
• Clinicians “in the room” enabling 111 staff to pass calls

directly to a GP

• Integrated IT: improving information flow and patient

experience and safety

• Direct booking of “in hours” GP appointments

GP out of hours

• Regardless of the future provider, will continue to offer

“traditional” service of telephone, face to face and home visits assessments.

• Islington CCG Board committed to ensuring high quality

service

• Until now activity split 40%tel, 40% F2F, 20% Visits
• By 2016- more telephone consultations from 111 GPs,

and possibly more F2F consultations from local GPs

(via the extended 8-8 GP working (seven days/week)

Engagement undertaken

• Public engagement January to March
• Community meetings undertaken with a wide

range of groups

• Survey Monkey questionnaire to all GP practice

patient groups

• Focusing on - Clinical Model & Procurement

Process

Engagement plan

Islington Borough User Group (iBUG) – mental health service users Drayton Park Women’s Crisis House Age UK Body & Soul (HIV) Elfrida Society (Learning Disabilities) Young Carers Disability Action Islington Joint meeting with Camden; open meeting, 23 February, 5.30pm – 7.30pm, St. Pancras Hospital Last Years of Life Group/Voices for Change, Bingfield Medical Centre Last Years of Life Group, Islington Carers Hub North Locality Patient Forum, Resource Centre, 19 March, 2.00pm – 5.00pm Central Locality Patient Forum, Venue tbc, 26 March, 5.30pm – 8.30pm South Locality Patient Forum, St Luke’s Centre, 31 March, 5.30pm – 8.30pm Community Members / Independent Patient Group Survey Monkey questionnaire to GP practice patient groups HealthWatch All GP practices in pan-Islington forum

Emerging themes GP OOH

• Everyone wants a high quality service (Patients, CCG Board,

GPs, patient community groups)

• Some people think this should be run and/or delivered by

Local GPs

• Others have focused on the need for “high quality GPs”- who

may or may not be local

• Service needs to be responsive to diverse language needs

and vulnerable groups

• Service needs to minimise unnecessary referrals to A&E or

999

Emerging themes - PPG feedback

• Following on from the December 14 PPG in South
• Provided a set of FAQ for any patient
• Sent a survey to all Islington PPG groups
• Asked for the survey to go to all the practices “virtual

patient groups”

• Asked all the CCG to undertake the same exercise

Emerging themes – re 111

• Combining NHS111 and GP OOH is a good idea
• NHS111 and GPOOH needs to be able to make good links with the

local health system

• NHS111 needs to be better at helping people with mental health

needs

• Service needs to be more responsive to diverse language needs

and patients with a disability

• Prescriptions, next day GP appointments, record sharing(with

consent) – all well received.

• NHS 111 needs more marketing

Next steps

• This phase of the engagement finishes end of March
• Report on the outcome of the engagement
• Finalise on-going public involvement in the procurement

process

• End March commence tendering process
• Finalise the service specification by the end of April

ready for the second stage of the procurement

• New service starts 1 April 2016

Involvement in the procurement Are you are interested in becoming involved in the procurement process? If so, please give your name to: Lizzie Stimson estimson@nhs.net

Questions

Questions

• Have you used NHS 111 or GP OOH service in the last

year?

• How would you rate your experience of NHS111 and OOH?
• When you call 111, how important would it be to you to be

able to talk to the following healthcare professionals?

• GP
• Pharmacist
• Nurse
• Paramedic
• Dentist
• Mental health professional
• Is there anyone else you’d like to be able to talk to? Please

specify

Questions

• Would you like the 111 or OOH service to be able to

book an appointment at your GP practice the following day if it was thought necessary?

• We want our OOH GPs to have a good understanding of

what local services are available in Islington when your GP is closed. How important is this issue to you?

• Is there anything else you would like us to consider?