NHS 111 Stakeholder Briefing NHS 111 can be designed locally to - - PowerPoint PPT Presentation

NHS 111

Stakeholder Briefing

Contact: Programme Manager: Dr Kathryn MacDermott, Assistant Director Strategy & QIPP Communications & Engagement Project Lead: Alex Louis

“NHS 111 can be designed locally to reach far beyond the initial vision”

NHS 111 Lessons learnt and shared understanding, NHS 111 Programme, Version 1.2, September 2011

A reminder…what is NHS 111?

• A new 24/7 telephone service which aims to make

it easier for people to access local health services when they urgently need medical help or advice but it's not a life-threatening situation (i.e. not a 999 emergency)

The strategic context

• Coalition government commitment to introduce a three digit

number to access non-urgent care nationwide by 2013.

“We will develop a coherent 24/7 urgent care service in every area in England that makes sense to patients when they have to make choices about their care. This will incorporate GP out of hour’s services and provide urgent medical care for people registered with a GP elsewhere. We will make care more accessible by introducing, informed by evaluation, a single telephone number for every kind of urgent and social care and by using technology to help people communicate with their clinicians.”

• Consultation for a three-digit number carried out in 2009

showed clear evidence of support from patient representative groups and clinicians.

• Early pilots introduced in 2010.
• London pilots due 2012

What are the benefits of NHS 111?

• Introduction of a consistent clinical

assessment tool and referral management.

• Reduction in attendances at A&E and an

increase in patients being directed and conveyed to the most appropriate care setting for their needs.

• Activity shifted to more clinically

appropriate, lower cost care settings.

• Reduction in ambulance ‘999’ activations

and conveyances to A&E.

• Reduction in unscheduled admissions by

directing patients to home-based nursing/care services.

• Information on the capacity of, and

demand for, urgent care provision available via Directory of Services (DoS) reporting, allowing commissioners to respond more intelligently to local needs/demands.

• Improved clinical governance of all

general practice and community services through caller outcome information.

• Signposting of access to NHS dentistry in

hours as well as Out of Hours (OOH).

• Improved end of life care services through

coordination of individual patient care.

• An increased percentage of patients

achieving preferred place of death.

Support for a three digit number

• DoH started work in 2008 scoping a single number to access NHS

urgent healthcare services

• Included public research which showed overwhelming support

for a ‘999 style’ memorable number

• Public support for introduction of 111 very high; 88% of people

interviewed said likely to use the new service

• Public support matched with extensive support from British

Medical Association, Royal College of General Practitioners & Royal College of Physicians

• Provider organisations including LAS, NHS Direct and out of hours

providers are positively engaged in 111 pilot

• All SHAs support the introduction of single number to access

urgent healthcare services.

NHS 111: more than a number

• Provides a definitive clinical assessment at the first point of

contact, without the need to call patients back.

• The service will direct people to the right NHS service, first

time, without the need for them to be re-triaged.

• It will be able to transfer clinical assessment data to other

providers and book appointments for patients when locally agreed and appropriate.

• It works alongside the London Ambulance Service (LAS) and

will be able to despatch an ambulance without delay and without the need for the patient to repeat any information.

Unplanned care

• Review use of urgent care centres
• Review use of walk in centres
• Develop and implement unscheduled care

strategy

• Implement 111

Key deliverables:

• Reduce the level of unscheduled secondary

care activity

• Reduce inappropriate A&E attendances
• Reduce A&E conversion rates
• Increase the volume of activity undertaken in

primary and community based services and local settings (at home/hospices)

• Reduction in readmissions

Key outcomes:

London 111 Operating Model

Integration with End of Life Register

ACCESS ANSWER ASSESSMENT

NHS Pathways Consistent assessment of clinical needs NHS 111 call advisers Locally commissioned call handling

APPROPRIATE CARE

Directory of local skills and services (CMS) Provided by each NHS organisation in a PCT area, including

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

999 A&E MIU GP in hrs GP OOH DN WiC Midwife Pharmacy

Rapid response nursing

Palliative care services, hospices

The future of Urgent and Emergency Care

NHS 111 national pilots so far

• NHS 111 launched in Aug 2010 in County Durham & Darlington, and

December 2010 in Nottingham City, Lincolnshire and Luton in total,

• ver quarter million calls received.
• System impact data released monthly by the Department of Health

reviewing the impact of NHS 111 services on A&E, UCC, Primary Care, ambulance services and NHS Direct.

– Durham and Darlington data compared with the same period from the previous year shows that A&E attendances decreased by 1%, in comparison to a 9% increase in A&E attendances for the same time period in the control site. This is equal to a net 10% reduction – OOH, WiC and UCC contacts have increased by 4% per cent compared to control site where contacts increased by 19% over the same time period. This is equal to a net reduction of 15%. – 45% drop in NHSD 0845 calls

• Majority of calls receive a primary care disposition this includes

pharmacy, community nursing, out of hours as well as in-hours primary care dispositions.

London roll-out process

• The Secretary of State set a deadline of April 2013 for NHS 111 service to be

available across England.

• DH requested firm 111 roll-out plans from SHAs be submitted in September

2011 plans needed to include the financial case.

• To ensure universal coverage by 2013 DH have said that where plans do not

exist, commissioners be expected to engage with NHS Direct as an ‘opt-in’ to work in partnership with ambulance and local GP out of hours providers to provide 111 services on an interim basis until a formal procurement process takes place.

• All London clusters have now submitted plans that ensure NHS 111 service

coverage through pilots by January 2013. London CCGs must endorse local plans.

• London is planning formal procurement of NHS 111 post pilots from 2014 –

with the early pilots intended a high quality, efficient 111 service integrated with primary and community urgent care systems.

July 2012 Oct 12- Jan 2013 July 2012 Jan 2013 June 12-Jan 2013 March 2012 Aug-Nov 2012

Geographic view of London pilot plan to meet coverage by April 2013

London plan by cluster

North Central London

Geographic Coverage: 17% of London population: Camden/ Haringey/ Islington/ Barnet/ Enfield Approach to identify a pilot partner : Plans to use a limited/closed competitive process to deliver a two- year pilot ahead of a pan London Plans to adopt Part B Restricted Accelerated procurement process to deliver a 2 year pilot ahead of a pan London procurement. Cluster initially secured commitment from CCG during October/ November 2011 of a procurement approach that limits supplier base and a111 go-live in January 2013. Newly proposed procurement approach encourages an open procurement process and earlier go-live to mitigate slippage . CCGs will need to confirm revisions to the plan during January 2012. Cluster then finalise local 111 service specification by March ‘12 based on local urgent care strategies Contract award planned for mid April 2012 contract mobilisation period from April to January 2013. Go live date: January 2013

Outer North East London

Geographic Coverage: 12% of London population: Barking& Dagenham/ Haringey/ Redbridge/ Waltham Forest Approach to identify a pilot partner : Previously nominated existing GP OOH provider to deliver a two year 111 pilot ahead of a pan London

• procurement. However CCG and Cluster agreed to cancel pilot arrangements with existing GPOOH

provider following legal advice on single tender award and risk of challenge. Plan to implement Part B Restricted Accelerated procurement process to deliver a 2 year pilot ahead of a pan London

• procurement. Revised plan to be agreed at ONEL Urgent Care Board, chaired and attended by the CCGs
• n 29th November. Once endorsed will require final sign off at Joint PCT Boards in January 2012.

Go live date: Issue tender January 12; contract award end Feb; mobilisation and go-live March to August 2012

East London & City

Geographic Coverage: 9% of London population by Tower Hamlets, City & Hackney, Newham Approach to identify a pilot partner : Completed limited competitive process to let an initial/ pilot phase contract for two years in line with future pan-London procurement. Cluster Board and CCG approved process, content they have sufficiently justified limiting supplier base. Preferred supplier now identified, to secure final Board and CCG sign off 8 Dec. Go live date: June 2012 City and Hackney; Tower Hamlets & Newham phased implementation from October 2012 – January 2013 (i.e. post Olympics)

South East London

Geographic Coverage: 21% of London population: Bexley/ Bromley / Greenwich/ Lambeth / Lewisham / Southwark Approach to identify a pilot partner : Plans to adopt Part B Restricted Accelerated procurement process to deliver a 2 year pilot ahead of a pan London procurement. CCG confirmation obtained on on accelerated procurement as earlier discussion supported a partnership arrangement between SEL existing GP OOH providers and NHS

• Direct. If insufficient progress made CCGs agreed to implement a limited procurement process to let

a pilot contract for two years. CCG need to agree to revised open procurement approach. Go live date: Jan uary 2013

South West London

Geographic Coverage: 17% of London population: Croydon/ Richmond/ Wandsworth/ Kingston/ Sutton & Merton Approach to identify a pilot partner : Croydon - completed limited competitive process to let pilot contract for two years in line with future pan- London procurement. Cluster Board and CCG’s approved process , content with commissioner justification for limiting supplier base. Preferred supplier now identified, in contract discussions, go live planned for March / April 2012 tbc with DH. Remaining SWL Boroughs plan to adopt Part B Restricted Accelerated procurement process to deliver two year pilot ahead of a pan London procurement. Secured initial support for go-live timelines and procurement in September, CCG Chairs sighted on change in procurement process but remain committed to go-live planned timelines will need final confirmation with all SWL CCGs following November 2011 change in CCG configuration. Go live date: Croydon – March 2012; remaining SWL boroughs phased from August 2012 to November 2012.

Inner North West London

Geographic Coverage: 8% of London population: Hammersmith & Fulham/ Westminster/ Kensington & Chelsea Approach to identify a pilot partner : Previously nominated existing GP OOH provider to deliver a two year 111 pilot ahead of a pan London

• procurement. However CCG and Cluster agreed to cancel pilot arrangements with existing GPOOH provider

following legal advice identifying potential breach of financial SFI ‘s/ SO’s and PRCC Guidelines Have implemented Part B Restricted Accelerated procurement process to deliver a 2 year pilot ahead of a pan London

• procurement. Tender published on Supply2Health; contract award planned for 23 January. Mobilisation to

commence Feb to July 2012 Go live date: Up to July 2012.

Outer North West London

Geographic Coverage: Geographic coverage: 10% of London population: Hillingdon/ Hounslow/ Ealing Approach to identify a pilot partner : Hillingdon previously nominated existing GP OOH provider to deliver a two year 111 pilot ahead of a pan London

• procurement. CCG and Cluster agreed to cancel pilot arrangements with existing GPOOH provider following legal

advice identifying potential breach of financial SFI ‘s/ SO’s and PRCC guidelines Now implemented Part B Restricted Accelerated procurement process to deliver a 2 year pilot ahead of a pan London procurement. Tender published on Supply2Health; contract award planned for 23 January. Mobilisation to commence Feb to July 2012 Hounslow and Ealing plan to adopt Part B Restricted Accelerated procurement process to deliver two year pilot ahead of a pan London procurement. Secured initial support for go-live timelines and procurement in September, CCG Chairs to confirm change in procurement process and go-live planned timelines. Hounslow plan to integrate procurement of 111 provider with re-tendering GP OOH services Go live date: Hillingdon went live March 2012 Hounslow/ Ealing phased go-live approach between October and January 2013.

Mid North West London

Geographic Coverage: 6% of London population: Brent/ Harrow Approach to identify a pilot partner : Brent & Harrow to adopt Part B Restricted Accelerated procurement process to deliver two year pilot ahead of a pan London procurement. Secured initial support for go-live timelines and procurement in September, CCG Chairs to confirm change in procurement process and go-live planned timelines. Go live date: Phased implementation with Brent and Harrow from October and January 2013 linked with Ealing (above)

Directory of Services: resilience and benefits

Resilience plans

• Additional services to be profiled: Mental Health (both Pathways and other referral), Specialist palliative

care service (for Co-ordinate My Care), LES/DES ( consistent with ‘Once for London’ management of LES and DES plans) and Emergency/OOH Dental (potential front-end service reconfiguration to use 111/DoS)

• Additional 111-readiness testing plans using London Top 10 Patient Journey scenarios
• Implementation of 111-DoS testing lessons learned
• Searching and reporting functionality developed for full user roll-out, with cost-effective training

solution

• Cluster infrastructure (e.g. governance, workforce planning) proposals to be approved and

implemented

• Sustainable provider profiling solution, e.g. London library of service templates
• Expansion of DoS to include social care, jointly commissioned health & social care services, voluntary

sector and grant funded services.

Benefits

• Cost savings from signposting high-volume ED patient flows to appropriate primary and community-

based services

• Robust 111-readiness testing pack for clusters roll-out to all London pilots
• Added value for stakeholders, especially clinicians (searching tool) and commissioners (reporting)
• Resilient and sustainable Cluster-based infrastructure

Directory of Services: attributes

• A timely and accurate suite
• f standard and bespoke

reports offering users, in particular commissioners, a powerful tool for transforming the patient journey cost-effectively

• A safe and accurate tool that

is valued by a wide range of stakeholders, and returns consistent service results whether used in 111 or by clinicians

• A safe and accurate

directory of London services to support 111, commissioning integration and other strategic health and social care initiatives

• A well-managed, London-

wide user community of commissioners, clinicians, providers and DoS administrators

Users Services Reporting Searching

DoS Implementation

Milestones and Timescales

December 2011

• Additional

services profiling

• Additional 111

readiness testing

• Review of

implementation

and Cluster infrastructure proposals January 2012

• Additional

services profiling

• Implementation
• f 111-DoS

lessons learned

• Emergency/

OOH dental services profiling

• Searching and

reporting roll-

• ut, with

training February 2012

• Additional

services profiling

• Searching and

reporting roll-

• ut, with

training March 2012

• Additional

services profiling

• Sign-off of

London library

• f service

templates April 2012

• nwards
• DoS

implementation/

handover to Clusters complete

111 pilot go-live 111 pilot go-live CmC go-live

CMS DoS

Partner Additional call demand handled by external

• rganisation. Includes health

information and web during the pilot phase.

The SEL 111 model

111 999 Cat C OOH NHS Direct

Provider(s)

Crisis Line 111 telephony cloud Provider(s) 111 call advisors NHS Pathways Triage

Ambulance needed? End of life register Repeat caller

Pathways disposition LAS

dispatches

Clinicians

3 5

GP OOH Provider(s)

2 1

1. Calls are prioritised to be answered. 2. Additional capacity is provided by an agreed partner, who also takes health information call. 3. The provider(s) acts as ‘virtual’ call centre for SEL 111 calls. 4. When a speak to/contact primary care provider disposition is OOH, the call is directed to the OOH GP 5. The model supports the links to the End of Life Register Other service providers

4

No Yes

SEL approach and progress

• The SEL 111 Programme Board will report to the clinical commissioning

groups and the SEL Clinical Strategy Group.

• 111 implementation group overseeing delivery of the project
• Profiling workshops to populate the directory of services (DoS) and

‘break the system’ events to allow clinicians and providers to test the voracity of the system have been held in south east London.

• A joint mental health profiling/discussion event with south west London

was held in October.

• Engagement with stakeholders is on-going – three clinical engagement

leads: Dr Ben Pert, Dr Kapil Mahna and Programme Board Chair, David Parkins

Stakeholder engagement activity

clinical

individual GP practice visits by SEL 111 clinical engagement leads, implementation team and cluster primary care contracting staff Break the system and DoS profiling workshops held September-October – more events and consultation planned for 2012 Updates and attendance at cluster unscheduled care boards LMC briefings via primary care contracting team

Patient/public

Regular presentations and updates to Stakeholder Reference Group Stakeholder update bulletins once provider appointed Presentations to HOSCs, community and patient groups Two community representatives on procurement panel (Greenwich & Southwark)

Questions?

Please contact the project team for further information or for a more detailed briefing on NHS 111

lam-pct.sel111@nhs.net Tel: 020 3049 3951

Alex Louis alex.louis@nhs.net Communications & Engagement project lead

NHS Choices Department of Health 111 research