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NHS 111 opens new front door to improved urgent care
Delivery of NHS 111 and General Practice Out of Hours services are to be brought closer together to provide patients with a “new front door” to urgent health care services.
The new service will offer patients improved access to a new 24/7 urgent clinical assessment, advice and treatment service – bringing together NHS 111, GP out of hours and clinical advice. The move is part of NHS England’s ongoing Urgent and Emergency Care Review and will see a streamlining of the way urgent care services are provided around the country.
It comes as local health services are responding to the highest ever number of ambulance calls, A&E attendances and emergency admissions in NHS history.
As part of this new service commissioners are being recommended to establish “urgent care clinical hubs”, which will provide clinical advice and support to patients as well as professionals working in out-of-hospital settings. Some of the clinicians and professionals that make up these hubs may be physically located in the Integrated Urgent Care call centre and provide a 24/7 presence, but more often they will provide this advice from their normal place of work.
As it gears up for this new service, NHS England has today published new commissioning standards guidance to commissioners on how to bring together call handling and assessment, clinical advice and treatment under a single commissioning framework.
Professor Keith Willett, NHS England’s Director for Acute Care, who is heading the review, said: “A fundamental redesign of the NHS urgent care ‘front door’ is much needed and now underway. This includes A&E, GPs, 999, 111, Out of Hours, community and social care services. Let’s make finding urgent help simple – 111 if it can’t wait until tomorrow, and 999 for real emergencies.
“Most patients access urgent healthcare through their own GP practice in the daytime and we expect this will remain the first point of contact in the future. But around the clock the ‘111’ number will find you GP and other urgent health care advice – so it makes sense to align the GP out of hours calls behind the same ‘111’ number.
“The 111 ‘front door’ is already directing people to who can best help them locally; this is taking a massive weight off our hospital A&E teams, our 999 ambulance paramedics and our busy GPs.
“The new standards published today build on the success of NHS 111 and will help deliver the benefits for patients set out in the Urgent and Emergency Care Review. This is all about ensuring patients get the right treatment, at the right place and at the right time, while also alleviating the pressure on our A&E and emergency ambulance services.”
Dr Ossie Rawstorne, Medical Advisor to NHS 111, said: “We already know that NHS 111 is helping shift the burden away from A&E and ambulance services. It currently deals with more than one million calls a month and, of those, just 10% lead to an ambulance being dispatched and just 8% are recommended to A&E.
“People call us knowing they will get sound advice from experienced clinicians if needed and directed to the best place for treatment, be that to A&E or an emergency ambulance or, as in the majority of calls, to their local pharmacist, a dentist or their local GP Out of Hours service.
“In some areas of the country NHS 111 and Out Of Hours services have had separate working arrangements that have been confusing for patients. This will ensure they are working more closely together and providing a better response to patients in need of help.”
Before today’s guidance was published widespread engagement has taken place through a variety of routes and with a wide range of external stakeholders, including the Royal College of General Practitioners (RCGP) and the British Medical Association (BMA). A Steering Group consisting of important stakeholders including representatives from the Royal Colleges, Out-of-Hours providers and patient groups critically reviewed its development.
The new standards are published as NHS England and Health Education England embark on plans to bolster the NHS 111 workforce.
The NHS 111 Integrated Urgent Care Workforce Development Programme aims to support the development needs of the existing and future NHS 111 workforce, and to improve services and outcomes for patients. This will be achieved by commissioners, providers and local education and training groups working together to develop new and innovative training based on best practice.
The programme will be designed to improve recruitment and retention by providing more opportunity for staff to pursue new career opportunities in health care, for example training for specialist and advanced level practice, for clinicians and health advisors.
David Davis, Paramedic and NHS England’s Clinical Lead for the Programme, said: “The value and potential of NHS 111 and integrated urgent care for the future is huge. A fully developed, highly trained and skilled workforce will help to ensure we continue to have a service which is safe, and effective in guiding patients to the right care.
“NHS 111 clinicians and health advisers are an essential part of a group of services such as GPs, pharmacy, dental, hospital and social care, working together to provide integrated patient care. Talking to frontline workers, providers and commissioners of NHS 111, we know there are areas which work extremely well and others that have challenges, such as the staff recruitment and staff retention. We now need to ensure that we invest in developing a skilled and valued workforce for the future.”
What we need from HEE in an integrated urgent care workforce plan similar to the one designed for NHS111 and reflecting the new commissioning standards. Dr Willett indicated at one o the seminars that HEE an NHSEngland were working together on a workforce plan. Given the lead in time this should have been thought of as part of the commissioning standard.
there IS NOTHING IN THE 2015/15 HEE plan on this nor is it part of the local workforce plan in our area.
Workforce planning should be an integral part of service planning not an after thought.
I am really pleased to read this comment. Important to transform NHS is to focus on urgent care and reduce unnecessary AE visits, hospital admissions, investigations and heroic procedures on elderly patients with multiple co-morbidity who need tender loving care. Many such patients are on many different medicine which makes them ill without any other benefit.
But one thing worries me is about skilled valued workforce. NHS has lot of value based work-force but what NHS lacks is value based leaders. Bullying of staff in ambulance service is staggering. Ambulance Trusts do not have good track record for looking after BME staff well as BME staff in most Ambulance Trusts are 6 to 10 times more bullied and discriminated.
I do hope leaders here look at BME issues and also make sure all leaders are appointed for values and are held to account.
You may wish to see this CQC video as to how we transformed Wrightington, Wigan and Leigh FT and its link to BMEs and also patient safety and staff well-being.
How much autonomy will be given to local CCG’s in applying this guidance in practice. For instance if the CCG wants to have 111 as one of the options for entry into the urgent care system provided that the system as a whole in integrated is this permissble.
Thank you for your comment.
We have consulted widely on the new Commissioning Standards which have support from clinical leads and have been formally approved and signed off by NHS England. Commissioners have a delegated responsibility for implementing these recommended standards locally and should be sure that there are good reasons for providing alternative routes of telephone access and that these do not merely serve to perpetuate existing arrangements for the sake of doing so.
I am delighted to see that the NHS is finally taking the bold steps necessary to deal with the challenges in urgent and emergency care. These challenges cannot be satisfactorily addressed unless the structural problems are faced up to, in particular the historic “silos” of care, dictated by an assumption that diagnosis and treatment must be “hand-on” and that each “silo” must perform its own triage in isolation. It is extraordinary that in the 21st century we can only deliver healthcare in person or, reluctantly, by phone – and only then if it is an out of hours emergency; the public are no longer prepared to accept that healthcare is by appointment at the convenience of the healthcare providers.
I believe that the proposals will greatly assist in addressing these issues. A single point of triage for urgent care, with fewer layers to pass through before diagnosis and treatment will be much more efficient and effective. It is also a model which will become even more efficient as new communications technologies, such as video calling, are belatedly applied.