The aim of this document is to provide better consistency in the integrity of the data entered by Directory of Service (DoS) regions, and form part of the wider DoS Quality Review undertaken by the National DoS Lead(s). Following the principles set out will provide a more cohesive and consistent approach to DoS profiling across the country.
The DoS is a central, web-based national database of a range of services involved in patient care. It was initially set-up to support users of NHS Pathways (NHSP); the Clinical Decision Support Software (CDSS) used in NHS 111, in some 999 providers and in other triage situations. It supports clinicians and non-clinicians in being able to make safe and effective referrals following a telephone assessment of a patient’s symptoms and is also used in tools such as 111Online, NHS Pathways Streaming and Redirection, NHS Service Finder and others.
Population and live maintenance of the data within DoS is the ultimate responsibility of the integrated care boards (ICBs). The entering and editing of the data is referred to as ‘profiling’, as each entry in the database is a DoS profile comprising of details of the service it relates to. Each provider listed is responsible for ensuring the details listed about their service(s) are an accurate reflection of what they are commissioned to provide. The profiling is completed by DoS Leads and DoS teams working on behalf of local commissioning organisations. DoS leads may be employed by one of the following:
- Individual ICB.
- Lead ICB on behalf of a number of associate ICBs.
- Commissioning Support Unit (CSU) on behalf of the ICB(s).
- NHS provider on behalf of the ICB(s) e.g. ambulance service.
Whilst it is recognised that DoS profiling should reflect local requirements, there are some best practice guidelines which must be adopted by DoS Leads and DoS teams throughout the country. Doing so has the following benefits:
- Assists local teams in optimising their DoS to meet strategic aims.
- Provide consistency for health advisors and clinicians answering calls for patients outside of their usual geography.
- Prevents border issues where unsuitable services from a neighbouring ICB are presented as an option to a patient.
- Provides an ongoing framework to measure the quality of DoS profiling against.
- Gives guidance on the preferred approach to profiling for those new to DoS or with less experience of how it works.
- Better use of more appropriate services that can support the UEC system.
Where a ‘profiling principle’ has not been adopted by an ICB or an area, it is expected there will be reasonable justification as to why this principle is not suitable for them. This will need to be supported by evidence that identifies potential future change requirements in the DoS infrastructure, which may require adaptation of profiling activities. Most principles in this document should be achievable now, however some may be aspirational due to current resource or infrastructure challenges.
2. Database structure and setup
This section covers the principles concerning the setup of the directory, and the local decisions and variations that govern how the database functions locally.
2.1 Ranking strategy
There are currently 10 categories in DoS. These enable commissioners to decide which service types they would like patients to be referred to and set a priority preference. Services ranked in category ‘1’ will return above services ranked in ‘2’ and so on.
- It is only necessary to place a service type in separate ranking categories where they may contain services that return for the same NHS Pathways outcome e.g. the ranking of dental services and primary care services could be considered in isolation of each other, as long there is no overlap in clinical profiling.
- Ranking should be agreed by the nominated lead for the ICB.
- Ranking should be reviewed annually, whenever a new service type is added, upon request of commissioners or upon recommendation by a DoS lead; whichever is the shortest timeframe.
The general recommendations to be followed when ranking services are:
- Specialist services to be ranked higher than more standard in-hours services such as GP practices where commissioned and appropriate.
- Alternatives to Emergency Departments (EDs) such as Urgent Treatment Centres (UTCs) should be profiled before Clinical Assessment Services used for validation purposes, unless co-located with ED.
- ED should always be the last option for a patient to be referred to.
- Service types which are not utilised within a ranking strategy should be in category ‘10’.
There will be occasions where specific service types must be ranked in a specific category in line with national requirements. These scenarios will be clearly communicated to DoS teams as and when they occur.
2.3 Search distance
The DoS has a default search distance of 60km north/south and east/west from the patient’s current location. In most cases, particularly in urban areas, this is too far and presents options on a DoS return beyond where the patient would reasonably be expected to travel. Search distance can therefore be modified for individual postcode group areas, to ensure a more appropriate set of results. Once a modified search distance has been agreed, conversations with 111 providers should take place to ensure that this is properly implemented.
Suggested methodology to determine search distance
- Identify the furthest distance that a patient would be required to travel to. There may be a single specialist service within your geography that serves a large area such as an entire ICB or even Region, for example, Eye Casualty. Identify the furthest point from this service that a patient would be required to travel and set this as your search distance.
- Disregard any services where the location is notional (e.g. IUC), as further profiles with notional addresses could be added to accommodate any reduction in search distance. However, profiles should only be duplicated if absolutely necessary, and requirements for this should be demonstrated using scenario testing and before implementing the new distances.
- Identify a central postcode within each postcode district. These will typically be **** 1AA for the Royal Mail address. A postcode table or the postcode search on www.royalmail.com/find-a-postcode will help you identify these. Providing search distances at postcode district level initially will help ensure that almost all new postcodes are accounted for without further work. If you require a more granular approach than this, please contact the national team for advice and guidance.
- Use service search on the DoS website to measure the distance from each identified postcode to the furthest identified service. This is effectively your scenario testing as you are ensuring that the reduction in search distance will not prevent required services from returning. Note that the results here are shown in miles and may need converting to kilometres. As an extra assurance, teams may choose to use the clinical search to identify any further gaps not identified using the service search.
- Add a buffer to this distance to account for the width and breadth of the postcode district. This will vary depending on the size of the district. All distances should be rounded up to a full kilometre.
- Ensure your process has sign-off from your local clinical governance group.
- Submit your chosen postcode distances to firstname.lastname@example.org.
3. Individual profile setup
This section covers principles concerning the setup of individual profiles, and how each part of a DoS entry should be populated and managed.
3.1 Demographic information
This field should contain Address details only. No commas or other special characters should be used. The only occasion where anything other than a correct and valid address should be entered is for duplicate profiles, or profiles that do not require an address because they operate as a remote or telephone only service. In this case, ‘Postcode for lookup purposes only’ should be added to this field, alongside an appropriate postcode determined by local DoS teams.
This field is auto populated once a valid postcode has been entered. This cannot be amended.
This should be the primary phone number that members of the public should use to contact a service. This field should never be populated with a number that is to be used by healthcare professionals only, as it may display on other NHS sites such as nhs.uk and 111 Online. Phone numbers should be added with no spaces as these will be formatted automatically by other systems taking DoS data.
This field should be used for numbers that healthcare professionals and those working on behalf of healthcare professionals can use to access a service. This number should differ to the Public Phone Number, and will typically allow the caller to bypass IVR lines. As with the Public Phone field, these numbers should be added with no spaces as these will be formatted automatically by other systems taking DoS data.
This field should not be used as fax numbers are no longer considered a secure method of communicating patient data. This field is under consideration for removal or renaming on DoS.
As with the non-public phone, this field should be used for email addresses that are not for use by members of the public. Care should be taken to ensure that the email address is valid, and correct.
This field should be used to enter details of a web page that is linked to this service. This ideally should be to a page linked to the service specifically, rather than the homepage of a provider that offers a range of services.
Referral information (disposition instructions)
Information about the service that is not already covered by other fields such as opening times or clinical profile can be added in this free text notes field. It should contain information on how to access the service, any specific requirements for attending the service, and any location information that is essential and not covered elsewhere. It is recommended that referral information should not exceed 60 words in length unless absolutely necessary. This is to ensure that information is clear and concise for DoS users who are directing patients to services.
Currently, NHS 111 is the primary user of this field, but the field is also utilised by 999 and NHS Service Finder users. Therefore, care should be taken to ensure that the notes are as clear as possible for all users. It is appreciated that this will likely result in the 60 word recommendation being exceeded. The NHS 111 information should remain at the top, with information that is relevant to other users presented next. For example:
Information for 111:
Information text here
Information for Service Finder:
Information text here
Professional referral information
This section is specifically designed to contain information about a service that will be presented to professional users of the DoS only, using a system other than NHS Pathways. The primary audience for this will be NHS Service Finder. The information can contain more specific and technical language than the referral information, and can contain more detail as it will usually not need to be read as quickly. This box should contain information about specific inclusion / exclusion criteria and details on referral method that must be followed. Although this box is designated for NHS Service Finder, there have been delays in the tool being able to access this information. It is therefore advisable to check with the NHS Service Finder team that this information can be viewed locally before making use of this box.
Public facing information
Despite the name, this field is not currently visible to the public. This field is used by 111 Online and the NHS Pathways Streaming and Redirection tool to determine which referral method is required i.e. whether a patient needs to call a service before attending, or to attend in person first. Guidance on how to ensure that this field is populated appropriately for 111 Online can be found here: 111online.github.io/nhs111-resources/
3.2 Endpoint details
Endpoints, in DoS profiling terms, are the addresses listed on DoS entries (‘Endpoint Details’ tab) which providers use to electronically send patient referral details to services, when they are selected from DoS. If no end-point is set up for the service then the referring party will only be able to ‘signpost’ the patient. Careful consideration must be given to implementing or changing existing endpoint detail. A change control process should be adopted to ensure that DoS leads, provider technical leads and the NHS 111 provider assess the impact and authorise any changes to any of the endpoint details before they are made. Incorrect endpoint details will result in message failures and/or an inability to view appointment rotas.
Endpoint addresses will be provided by the receiving system. For most endpoint types, this will be a string of text that resembles a web address. For e-mail, this can only be a valid email address that supports the required security standards for the transfer of patient information. Only shared or group mailboxes ending in “nhs.net” or “gcsx.gov.uk” should be added without further checks. All other email addresses, including “nhs.uk” addresses should be checked to confirm if the security requirements are met. In most cases, the link below should verify whether an email address meets the required standard: digital.nhs.uk/services/nhsmail/guidance-for-sending-secure-email
If there is any uncertainty, the national DoS team should be contacted for assistance. Personal email addresses should not be used. If no suitable shared mailbox exists, the service must create one in order to receive messaging via email.
For “telno”, this will be a valid phone number (DDI) on which a patient can be warm transferred to the service. It is not to record any phone number on which a member of the public can directly dial that service and the call handler must not share this phone number with the caller.
Detailed guidance on how to set up each type of endpoint can be found here: future.nhs.uk/UECDOS/view?objectId=51239813
3.3 Duplicate profiles
Duplicate profiles should only be used when absolutely necessary as they increase administrative burden on local DoS teams and increase clinical risk.
Examples of when duplicate profiles may be necessary include:
- Geographical coverage beyond the search radius, for example an IUC service covering a number of ICBs.
- Border profiles to ensure the correct IUC service returns for registered patients.
- A change in clinical offering during the opening hours.
- A different naming, ranking, referral method or disposition instruction requirement at different points during the opening hours, for example if a service is available by appointment booking only at certain times.
- A service requiring different instructions or different referral methods for patients accessing via third party applications e.g.111 Online, NHS Service Finder and the Streaming and Redirection Tool.
When duplicating profiles, consideration should be given as to the appropriate referral roles on each of the supplementary profiles.
If a number of services are commissioned from the one provider, and demographic details are the same (including team type, location, opening hours and referral method), it may be possible to incorporate these on the same DoS profile providing due consideration is given to any potential conflicts within the clinical profiling.
3.4 Control Service
There are seven service statuses that DoS profiles can be set to:
Commissioning should be for new DoS profiles that are in the process of being set-up. This is likely to be for new services, services being modelled, or services that are moving to a new provider. On creation, all profiles will automatically default to this setting.
Pending should be for new DoS profiles that have been set-up, any testing completed, have received sign-off (as per the local governance process) and are now waiting to be made active. Pending is not always used if setup to active has been agreed as per local governance. An example of when to use Pending could be when a profile has received full sign off and a go-live date that is in the near future has been agreed.
Active should be for any DoS profile that has progressed through ‘commissioning’ and ‘pending’ (if required) statuses and is now available to be searched by DoS users. Most DoS profiles should be set with this service status.
Suspended should be for any DoS profile where the service is unavailable for a period of time or until further notice but is likely to be available again in the future.
Closed should be for any DoS profile where the service is no longer available, but the profile may be required in the future (for example a pop-up clinic for the winter period which may be re-commissioned the following year, or a service moving to a new provider in the future).
When some services close (particularly services patients are registered to), it may be necessary to keep the profile active for a period of time with information about what alternative services patients should be accessing. An example could be a GP practice that has temporarily closed due to unforeseen circumstances and has made arrangements with another practice for its patients to be seen there.
Retired should be for any DoS profile where the service is no longer available, and there is no future use for the profile. If a service is put into retired status, it should have all child profiles removed and the service type should be changed to ‘Retired’. It is good practice to add the word ‘Retired’ as a prefix in the service name. These profiles are purged on a periodic basis by the NHS Digital team when also moved to the retired service type, so if there is any doubt as to whether the profile is needed again, it should not be set as retired.
Template should be for any DoS profile which is used to populate other DoS profiles either in-part or in-full. It may be advisable to retain the most recent templates used to update key services.
All services on the DoS must contain an ODS Code. Wherever possible, this should be the real and correct ODS code for the service. However, DoS does not allow for more than one page to have the same ODS code. In this instance, an appropriate suffix should be added to the end of the standard code for each additional page. For example: A1234001, A1234002 etc. The vast majority of services should contain an ODS code, however some services such as smaller private providers may not. In this instance, the full DoS Service ID should be copied into the ODS code field. This field should contain letters and numbers only. No special characters should be used.
The service name is primarily used for administrative functions, as most systems that view DoS now use the public name. Services should be prefixed with an abbreviation of the service type. In most (but not all) cases this will match the service type that the service has been profiled as. The service name should be suffixed with the location of the service or the geographical area it covers, if this is not already made clear by the name of the service. For example, there would be no need to add a suffix to the service name ‘UTC: Milton Keynes Urgent Treatment Centre’, but there may be a need to add a locational suffix to the service name ‘UTC: Putnoe Walk-In Centre’ as this may not be clear to those without local knowledge. For example ‘UTC: Putone Walk-In Centre – Bedfordshire’ Within the service name, a colon ‘:‘ should be used to separate the prefix, and a short hyphen ‘-‘ should be used to separate the service name and location as shown in the above examples.
This field contains the name that is displayed to users of 111 Online, Streamer and Redirection Tool and some 111 Provider clinical systems. This field should not ordinarily contain a prefix and should be named according to how this service is known locally. A good rule to apply is to use the name used on signs at the service itself. For example, ‘Milton Keynes Urgent Treatment Centre’. Depending on the name of the service, there may still be a need to add a locational suffix. For example, ‘Putnoe Walk-in Centre – Bedfordshire’.
Guidance on how to ensure that this field is populated appropriately for 111 Online can be found here: 111online.github.io/nhs111-resources/
3.5 Clinical details
Only Return if Open (ORIO)
Typically, a DoS service will return if it’s open within the disposition timeframe reached by NHS Pathways. For example, if a 4hr disposition timeframe is reached at 08:00, and a UTC with that code profiled opens at 10:00, that service will return. While this is often helpful, it can cause issues in certain circumstances. For example, generally an IUC Treatment profile that covers the out of hours period would not accept referrals until the out of hours period starts. To allow for this, DoS has the functionality to set services to ‘Only Return if Open’. The profile can be set to start returning at the precise time that it opens, 15mins or 30mins before it opens. It is down to local services and commissioners to determine which best suits local profiling needs, with consideration of how this would affect other services and what gaps may be present in the system. For example, If a GP closes at 17:30 but GP OOH opens at 18:00 and 0 minute ORIO is applied, a gap in service is then created.
3.6 Search rankings
Limit allows services to be limited to a geographical boundary such as an ICB or Local Authority District which will ensure services do not return for patients inappropriately. Most services are likely to require a limit to be added, as most will be commissioned for a specific footprint. Examples include Integrated Urgent Care (IUC) services, Community Nursing, Urgent Community Response, Mental Health, and most UTCs.
As well as the option to limit to ICB and Local Authority, DoS Leads can create ‘Locally Defined Areas’ or ‘LDA’s. These are bespoke areas created by DoS leads providing a group of postcodes that form a geographic area to the National DoS Developments team. These can then be made available in DoS. Once created, the responsibility for maintaining these LDAs, adding new postcodes and removing retired postcodes, will sit with local DoS teams.
Applying promote will have the effect of ‘demoting’ a service for a neighbouring area. For example, a UTC located in Northamptonshire ICB has ‘promote’ applied. It could return for a patient located in a neighbouring ICB (if the search distance allowed). However, it would be pushed down the list of returns and only appear below any services in that neighbouring ICB. For this reason, Emergency Department services should always be promoted to an area that is far outside of the ICB in which they are located. This is to force it as far down the list of DoS returns as possible.
4. Service types
This section describes the key service types available within the Directory of Services, and the appropriate use for each. A Service Type is a way of categorising services.
4.1 Emergency department (ED) catch-all
Services in this service type will be used for catch-all events. A catch-all is where there are no services returning on the DoS within the search parameters which meet the patient’s requirements (SG/SD/Dx combo). ED Catch-All service types will present with the suffix ‘(CATCH ALL)’ regardless of the clinical profile, capacity status or search distance. Catch-all profiles should have no clinical profiling and should mirror the demographic information of Type 1 EDs.
4.2 Emergency department (ED)
All standard ED services should be placed in this service type.
Eye emergency departments should be placed in the eye casualty service type.
Services in the ED service type should not have any GP practices in Service Referrals, or be limited to any specific ICB, LDA or LAD. These services should also not have any Primary Care level SG/SD/Dx combinations profiled against them.
EDs should have promote applied, but this should be for an area that is well outside of the standard DoS search distance. For example, an ED in London could have a promote applied for Devon ICB. This has the effect of forcing the service further down the list of DoS returns.
4.3 Dental care services
This service type should contain in-hours dental practices.
NHS dental practices may be commissioned to provide urgent access slots. Unavailability of these slots should be managed using the capacity status functionality.
This service type should only be used for service that provides emergency dental treatment and are profiled with Dx118. These must be open access, and not require patients to be registered with a specific dental practice or group of dental practices. Dx118 should be profiled only to services within this service type. All Dental services that do not fit this criterion should now be profiled under the appropriate alternative dental service type.
Dental Urgent Care
This Service Type should be used for any Dental services that provide same day dental care, but do not meet the standard of a Dental Emergency Service. This could include local providers that require patients to be known to a local Dental practice, or group of practices.
They may be open during the in-hours period and/or the OOH period.
This service type should contain dental services that are able to provide assessment and/or treatment in a patient’s home.
4.4 Pharmaceutical services
There are four service types for pharmacy services:
Services which provide standard pharmaceutical services should be profiled in the Pharmacy service type. This is the case regardless of whether or not the pharmacy is CPCS registered. If the pharmacy is CPCS registered, a profile with the standard pharmacy template applied should be profiled within the Pharmacy service type.
Services offering an enhanced level of pharmacy provision, such as CPCS, should have additional profiles, with these additional codes only, in the Pharmacy Enhanced service type.
Pharmacy urgent medicines supply
Services signed up to CPCS, or those which offer another form of urgent medicines supply commissioned separately to the core pharmacy offering, should have an additional profile in the Pharmacy Urgent Medicines Supply service type, profiled with these additional codes only.
Pharmacy distance selling
This service type is used for a service that offers delivery of medication and filling of prescriptions from a remote location. These services typically do not provide facilities for face-to-face consultation, and so should not be assigned the standard pharmacy service types. Any service that provides both standard face-to-face pharmacy services as well as distance selling should be profiled under the standard pharmacy service type.
4.5 Mental Health
Mental health crisis
Mental health services aiming to divert patients with suicide ideation away from Emergency Departments should add the relevant high acuity Symptom groups, Symptom Discriminators and Disposition codes.
All services that form part of the Mental Health Crisis Care pathway should be included on the DoS. These should be under the Mental Health Crisis service type.
Ensure that where available, endpoints are added to Crisis Support services to enable direct referrals from NHS 111.
Mental health services aiming to divert patients with lower acuity mental health needs away from local primary care services should add the relevant low level acuity SG/SD/Dx combinations, to ensure patients are appropriately referred.
All Section 136/Health Based Places of Safety should be profiled on the DoS to help ensure that people (particularly children and young people) are not held/assessed in police cells.
Consider whether any third sector organisations that can provide support to patients are profiled on the DoS. For example, Crisis Cafés, Age UK Dementia services.
4.6 Primary Care Network Services
Primary Care Network (PCN)
This is a parent service type that is NOT intended for services that contain clinical profiling. These services should be named using the full official name of the Primary Care Network, with the Suffix ‘PCN’. For example, ‘Evexia Health PCN’ All services that are provided by the PCN, Including GP Practices, District and Community Nursing, and any GP Access Hubs that provide appointments to patients registered with a member practice.
Primary Care Network (PCN) Enhanced Service
This service type should be used for services that provide an extended hours GP service for patients registered with a practice within a PCN. This replaces the previous ‘GP Access Hub’ service type.
4.7 GP in-hours
DoS profiles in this service type should as a minimum cover the core contracted hours of 8.00am to 6.30pm Monday to Friday. However, some may offer extended opening hours.
Where a surgery is not open for the entirety of the core contracted hours, there should be clear signposting to the alternative cover provided. This is sometimes referred to as marginal cover (e.g. 8.00-8.30am or 6.00-6.30pm). This signposting may be on the GP answerphone message or in the DoS disposition instructions.
Where a branch surgery or a group of surgeries are closed for part of the day (e.g. for training) and cover provided by the group practice or another provider(s), the GP in-hours profiles should have their opening times amended to show they are closed. There should be a separate, dedicated DoS profile set to open for the covering service, with a matching service type (e.g. IUC). The changing of times on the DoS profiles should be achieved using the specified opening times functionality unless the closure is a weekly event.
The GP in-hours profile should be restricted using service referrals to only return for patients registered at that practice.
It is recommended that GP in-hours service type should be ranked higher than the GP OOH service type, to ensure that the GP surgery is offered to a patient in preference to the out-of-hours service if both are open during the disposition timeframe. It is appreciated that this is dependant upon local commissioning arrangements.
4.8 Same Day Emergency Care (SDEC)
Same Day Emergency Care Services are in-hospital services for patients outside of the ED setting. SDEC services may vary considerably in the conditions that they can see, and in the referral route required. Due to the nature of these services it is advisable to work with Ambulance services to ensure that these services are available on any tools they may use to access DoS, such as Service Finder.
4.9 Sexual Assault Referral Centre (SARC)
This service type should only be used for services that are officially designated as Sexual Assault Referral Centres. The national template for these services should be applied as a minimum standard, but additional local profiling can be added as required.
4.10 Sexual health
Integrated Sexual Health services can include emergency contraception, Termination of Pregnancy (ToPs) referrals, STI testing, sexual health clinics etc. These can be a mixture of booked appointments and walk services. Starter templates are available to assist with profiling, however as there is likely to be significant variation in local service provision, we strongly advise that contact is made with the service and a bespoke profile is created.
4.11 Maternity and neonatal
This service type should only be used for maternity and neonatal services that are provided in an acute hospital setting and should not be used for Community Midwifery services.
This service type should be used only for services that provide midwifery services within the community, and not in an acute hospital setting. Any services that provide services in an acute setting should be profiled under the Maternity and Neonatal service type.
4.13 Early Pregnancy Assessment Unit (EPAU)
This service type should only be used for services that officially designated as an EPAU and are able to accept patients who are 20 weeks pregnant or less. As a minimum, the latest version of the service template *Service* Template – Early Pregnancy Assessment Unit (EPAU) vx.x must be applied.
4.14 Urgent community response
Urgent Community Response is a national service with a set of national standards. Only services that meet these standards should be profiled in this service type. Generally these services are accessible by clinician only, and there is a requirement that the services must accept referrals from 999 and 111 clinicians.
These services are likely to cater for a wide range of other conditions and circumstances, so it may be that additional codes can be added locally. In order to make the service provision clear, ‘Urgent Community Response’ must be written in full in the service name.
There are a range of other codes available to support profiling for service search tools which should be added as per local agreement and governance.
4.15 Urgent treatment centre
Urgent Treatment Centre is a national service with a set of national standards. Local profiling will vary, however consideration should be given to whether the national template for this service type could be used as a minimum standard. Depending on local commissioning arrangements, such as opening times and location of the UTC, it may be possible to remove codes from the nearby ED profiles, if they are profiled in the UTC profile. However, careful consideration should be given to the effect this could have on catch-all instances before making any changes. For further guidance on profiling of Urgent Treatment Centres please see UTC Principles for DoS profiling v0.9 – DoS Collaborative online Workspace (CoW) – FutureNHS Collaboration Platform.
4.16 Urgent Treatment Centre (UTC) co-located with ED
This service type is to be used only for a UTC that is located on the same site as an ED, and has a mechanism of referral in place with the ED. This referral mechanism must allow the patient to bypass the normal ED triage procedures and avoid duplication. We strongly recommend that clinical profiling that is present in this service type is removed from the ED profile. For further guidance on profiling of Urgent Treatment Centres please see UTC Principles for DoS profiling v0.9 – DoS Collaborative online Workspace (CoW) – FutureNHS Collaboration Platform
4.17 Integrated urgent care services
These are services that are provided as part of the local Integrated Urgent Care offering. With the exception of certain IUC Treatment Centre services, these services should be profiled under the IUC provider parent services.
Integrated urgent care (IUC) clinical assessment
Clinical assessment services are provided from a remote location. A postcode should be chosen in a central point of the geography covered and ‘Postcode for lookup purposes only’ should be added to the address field. Duplicate profiles may be needed if the service covers a very large geography, or if one provider covers multiple ICBs. These services will provide remote consultation and assessment of cases referred by 111 and possibly other providers. These services will not offer a face-to-face assessment (Integrated Urgent Care (IUC) Treatment should be used in these instances) and should not be used for ‘validation’ purposes (Integrated Urgent Care (IUC) Validation should be used in these instances).
Integrated urgent care (IUC) pharmacy clinical assessment
Pharmacy pharmacy clinical assessment (CAS) provides remote assessment and management of cases requiring input from a pharmacist. A postcode should be chosen in a central point of the geography covered and ‘Postcode for lookup purposes only’ should be added to the address field. Duplicate profiles may be needed if the service covers a very large geography, or if one provider covers multiple ICBs. This service will typically be pharmacist-led, and will manage cases relating to medication enquiries, complex repeat prescriptions, and potentially other pharmacy related queries. Profiling will typically include most of the codes found on a standard pharmacy profile, but this can very much depend on local decisions. Some may choose to profile only codes that are highly unlikely to need a face-to-face assessment.
Integrated urgent care (IUC) dental clinical assessment
The service is designed to provide remote assessment and advice for dental conditions and is managed by dental clinicians. A postcode should be chosen in a central point of the geography covered and ‘Postcode for lookup purposes only’ should be added to the address field. Duplicate profiles may be needed if the service covers a very large geography, or if one provider covers multiple ICBs.
Integrated urgent care (IUC) validation
This service type is similar to a clinical assessment service in that it offers remote assessment of cases, but these services focus specifically on re-validation of outcomes reached by 111 and 111 Online and 999. The most frequent use case for this service type is ED validation, but it may also be used for validation of primary care, ambulance, and other outcomes according to local need. It is important when profiling this service type to assess the benefits of validating certain codes. For example, it would be poor use of clinician time and a poor patient journey to validate cases that will require a face-to-face assessment the majority of the time.
Integrated urgent care (IUC) treatment
This service type should contain IUC services that offer face-to-face assessment and treatment. These will typically be the services that previously would have been referred to as a GP out of hours base. The primary use case for these will therefore be the treatment and assessment of Primary Care during the out-of-hours period. Local commissioning arrangements will determine whether these can be accessed directly by NHS 111 health advisors, or whether a case must go through a clinical assessment service first.
4.18 Virtual ward
A virtual ward (also known as hospital at home) is a service that allows patients to get hospital-level care at home. People on a virtual ward are cared for by a multidisciplinary team who can provide a range of tests and treatments. Patients are reviewed daily by the clinical team and the ‘ward round’ may involve a home visit or take place through video technology. There are a variety of specialities that could provide care through a virtual ward setting, and so there is no minimum clinical profiling. However, only services that are officially designated as Virtual Wards or Hospital at Home services should be profiled under this service type.
4.19 Hospital streaming
The Hospital Streaming Service type is designed exclusively for use with the streaming and redirection tool for onsite services. Any services located outside of the hospital, profiled for the streamer and redirection tool should use the relevant service type. Using the Hospital Streaming Service type for services that are located offsite will cause confusion because the service type causes a change in the text presented to the patient advising them to attend an onsite service.
4.20 Infection hub
This service type is for all acute infection hubs, including, but not limited to acute respiratory infection hubs. There is limited consistency in how these services should be profiled, as each may accept referrals from different user groups and therefore contain different profiling elements. These services should, however, be exclusively for the assessment and treatment of a potential acute infection.
5. Referral roles
Referral Roles are used to determine the type of user and system that is able to see each DoS profile. Without the correct referral roles in place, a service will not display. Below is a list of available referral roles, and the use case for each.
This role is currently not used by any systems accessing DoS therefore should not be used
111 telephony referral
This referral role should be profiled to any service that accepts referrals from 111 Telephony. There is currently no distinction between clinical and non-clinical users within the 111 service, so this referral role will make services accessible to both. There are currently several provider specific 111 Telephony referral roles (with the suffix of the provider). The use case of these provider specific referral roles is extremely limited and timebound, and the national DoS team should be consulted for discussion before these are used.
This referral role is used by NHS Service Finder. If a service is to be displayed in Service Finder, this will need to be added.
This referral role can be used by IUC CAS services that use their own instance of NHS Pathways. Not all providers use this, as some share their instance of Pathways with the 111 service, and will use an appropriate 111 Telephony referral role. Certain providers may use a bespoke CAS referral role that has the name of the provider as a suffix. Local providers should be contacted to verify the correct local process. The Regional and National DoS teams can be contacted for guidance if needed.
This referral role is for 999 services that use NHS Pathways as their clinical triage tool. Discussions should be held with local ambulance services to determine whether this is required. The Regional and National DoS teams can be contacted for guidance if needed.
This referral role is used by NHS 111 Online and should be added to all services that should be visible to NHS 111 Online. It is preferable that patients receive the same range of services via the Online route as they would via Telephony. Exceptions to this could be clinical queues that are specifically designed for 111 Telephony cases or for NHS 111 Online clinical callback profiles.
This referral role determines which services are pulled into the NHS public-facing website and are presented to patients when a search for certain services is performed. This includes emergency departments, urgent treatment centre’s and urgent care. This role should be applied to core profiles only, and not to any duplicate profiles, or profiles which contain ‘dummy’ addresses and postcodes. It should also only be added to services that are accessible to members of the public, and should not be used for services that need to be accessed via NHS 111, or that require a referral from a clinician.
ED streaming referral
This referral role is used by the NHS Streaming and Redirection tool. This can be added to services that are also accessible to telephony, or to pages that are specifically for the NHS Streaming and Redirection tool.
This referral role is designed to be added to any service that does not accept any referrals. This could be for parent services such as Region or ICB pages. The purpose of this referral role is to be used as an easy way to identify such pages within reports, and as a way of removing other referral roles if needed by bulk updating with only this referral role. This role should never be used in conjunction with any other.
6. Service attributes
Service attributes are an additional profiling option which affect the interaction between the system searching DoS and the service returned.
This service attribute is used to prevent a service from being selected unless an appointment is booked. This therefore prevent a service from being used if there are no appointments available, or if there are no appointments available within the required disposition timeframe. When adding this attribute to a service it is important to note that not all 3rd party systems are capable of using the attribute to inform system behaviour. Therefore, it is necessary to continue to maintain the referral notes on the service to indicate that referral is by appointment only. Care should therefore be taken to ensure that this is appropriate, as it could result in services lower down the ranking order being selected in place of top level services.
This section covers the responsibilities and processes that surround appropriate governance of the Directory of Services.
7.1 Locally commissioned services
DoS Leads and teams may or may not have a clinical background. As the clinical profile will inform referral decisions for all users of NHS Pathways, clinical oversight is essential to ensure it is safe. The following principles are to support and inform regional governance
Any health services or healthcare-relevant social care services commissioned by NHS England, ICBs or any other relevant body should be included in DoS.
The nominated operational lead and contracting manager responsible for the service(s) should both have visibility of any demographic/administrative changes.
In certain circumstances if the permissions allow and appropriate safeguards, reporting and procedures are in place, it is possible for administrative changes to be made or proposed by the providers directly, including the NHS 111 providers.
Care should be taken when amending opening hours that these are in line with the commissioned opening hours for the service.
Any clinical changes to a DoS profile should be agreed by the nominated clinical lead for the service(s) and ICB clinical leads prior to being implemented; however, removal of clinical codes can be agreed by the commissioner without consent of the provider.
The DoS Lead should make use of call routes (including Pathways Web), predicted volumes from beta testing (when available), descriptions for SGs, SDs, Dxs and combinations thereof (when available) and NHSP clinical queries calls to assist the clinical representatives in understanding the context and impact of any new clinical codes.
Clinical changes to specific services (dental practices, GP practices, opticians and pharmacies) can be agreed ‘in bulk’, as the core profile should be the same across all services, and agreement by individual services would be untenable.
Clinical profiles should be regularly compared against the national template and the latest NHS Pathways updates to ensure consistency and avoid missing codes.
Clinical codes may potentially be removed from lower-ranked services to encourage selection of higher ranked services. However, consideration should be given to what would happen should the higher ranked service become temporarily unavailable during the 24-hour period (e.g. red capacity status) to avoid a catch-all event.
Depending on local processes, Service type Z codes may be able to be applied without the prior agreement of the clinical representatives. Profiling of clinical Z codes should follow the same governance framework as for NHSP codes.
Clinical DoS Leads may have devolved responsibility to undertake the clinical sign-off on behalf of the commissioner.
Overall responsibility for the accuracy of the content of DoS, and the appropriate governance being applied, sits with the assigned DoS Lead and DoS teams.
7.2 Non-commissioned services
In the absence of a formal commissioner, the local clinical governance lead or their delegate is able to provide sign-off for any clinical changes.
7.3 National services
Some services are delivered nationally. Whilst there is a desire for local areas to be able to access them on DoS, the responsibility for profiling the services doesn’t immediately sit with local teams.
National bodies may have local area teams which can be profiled on the DoS.
Regions wishing to profile national services may do so then submit the profile(s) to the National DoS Lead(s) who will maintain a register of services profiled.
Other regions will be able to access the register of national services profiled to help inform their local profiling. However, where profiles are duplicated to cover additional geography, the governance arrangements will sit with the DoS region where the profile resides.
8. Capacity status
It is essential that DoS profiles accurately reflect the capacity of services that are open to receive referrals. This is achieved using the capacity status tab, where services can be set to green, amber or red. This is different to the capacity grid functionality within DoS and there is no direct correlation between the two.
Green – a service has capacity. The service is able to accept referrals and likely to meet any disposition timeframe.
Amber – a service has limited capacity. The service is able to accept referrals, but they are busy and may not be able to meet the disposition timeframe. Alternative services should be considered where possible.
Red – a service has no capacity. The service is not able to accept referrals or has run out of appointments. Services will not present as an option.
8.2 Updating the capacity status
There should be a locally agreed Standard Operating Procedure (SOP) in place to determine how changes to capacity status are made on the DoS.
Consideration needs to be given to the following:
- Whether catch all events will be triggered by a service updating to ‘red’ capacity.
- Whether senior approval is needed (if this is the case, details of the approver should be added to the notes field).
- What escalation procedures should be followed.
- Who makes the capacity status changes and whether appropriate training and permissions are in place with 24/7 availability.
- Who is responsible for the audit trail.
Triggers for changing the capacity status to amber or red should be in the escalation procedures for individual services.
Publication reference: PRN00209