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.”