The Next Steps on the NHS Five Year Forward View outlined the importance of enhancing NHS 111 services to help address the rising pressure on urgent and emergency care services and the fragmented nature of out-of-hospital services. NHS England has worked collaboratively with clinicians, commissioners and urgent care providers to develop a new national service specification for the provision of an integrated 24/7 urgent care access, clinical advice and treatment service (incorporating NHS 111 call-handling and former GP out-of-hours services). It outlines the steps that commissioners must take to deliver this important transformation and to move from an ‘assess and refer’ to a new ‘consult and complete’ model of service delivery.
Integrated Urgent Care / NHS 111 Workforce Blueprint
The Workforce Blueprint has been developed to support the workforce element of the Integrated Urgent Care Service Specification.
It includes a new Career Framework for staff at Skills for Health Levels 2-6 and 7-9. The Framework offers clearly defined roles, supported by competency-based job descriptions and person specifications for staff operating in a call centre environment.
This standardised approach will help Integrated Urgent Care/NHS 111 provider organisations recruit, develop and retain a professional workforce, with the right skills and competencies, to continue to provide the highest levels of patient care and safety. It also provides staff with opportunities for career development and progression. This is achieved through:
- Ensuring a minimum standard of competence at each level, thereby ensuring consistent quality for patients and callers across England.
- Supporting provider organisations in improving both internal and external recruitment, by attracting, retaining and motivating the best people.
- Providing opportunity for career progression and professional mobilisation – creating a pipeline for new nurses, paramedic, pharmacists and other clinical professions through a vocational model.
The Workforce Blueprint also provides guidance on key topics such as apprenticeships, accreditation of training and qualifications, workforce governance, leadership development and workforce mental health and wellbeing.
Key Performance Indicators
The revised Key Performance Indicators (KPIs) aim to improve understanding of how the urgent care system is performing overall and drive up performance to ensure patients receive the best possible clinical outcomes through a more balanced consideration that more accurately reflects the three domains of quality (providing patient safety, effective care, and delivering a positive patient experience).
Developed with significant stakeholder collaboration, the document details the following;
- processes by which data will be collected, including timing and financial implications
- broad next steps needed to start producing data
- specification, sources and accompanying issues for the new Key Performance Indicators (KPIs) that are designed to show whether the service is being delivered successfully
- full data that will be collected regularly by NHS England, including the KPIs
- how the KPIs supersede existing measures
- recommendations for further data items that will assist with monitoring of the service.
Integrated urgent care commissioning standards
This document outlines the standards which commissioners should adhere to in order to commission a functionally integrated 24/7 urgent care access, clinical assessment, advice and treatment service; aiming to incorporate NHS 111 and Out of Hours services into a coherent service model.
NHS England has published two further supporting documents:
- The Quick Guide: Best use of unscheduled dental care services provides practical information for (both routine and unscheduled) dental providers and commissioners on what they can do to improve dental unscheduled care for patients over the winter period, and beyond.
- The Quick Guide: Extending the role of community pharmacy in urgent care provides practical tips and case studies for providers and commissioners on how to extend the role of community pharmacy to relieve pressure on urgent care
Commissioning a functionally integrated urgent care access, treatment and clinical advice service
This letter, from Dame Barbara Hakin, regarding the commissioning of a functionally integrated urgent care access, treatment and clinical advice service, builds on the recommendations in earlier correspondence and outlines the steps that commissioners should consider in relation to an essential part of the transformation of NHS urgent care services.
Urgent repeat medication requests
At peak times for NHS 111 services there are significant numbers of calls for urgent repeat medication. This results in booking patients into GP out of hours (GPOOHs) appointments to obtain a prescription and for the out of hours services to then arrange for that prescription to be collected by a patient or carer or faxed to a pharmacy that is open near to the patient. All of this takes up time for the NHS 111 provider and GPOOHs service which could be used for patients with higher acuity need.
The Urgent Repeat Medication Requests Guide provides details on how NHS 111 services can establish a direct referral to a pharmacy that is commissioned to provide urgent repeat medication as a local NHS service. The patient journey ensures the patient is directed to the nearest pharmacy without the need of a GPOOHs assessment and the pharmacist ensures the governance of the process is adhered to by informing the patient’s GP of any repeat supply.
Commissioners of NHS 111 services and local community pharmacy services are encouraged to use this guide to inform the transformation of urgent care by shifting the burden of repeat medication requests away from GPOOHs services and other urgent care settings.
NHS 111 clinical governance toolkit
The purpose of the NHS 111 clinical governance toolkit is to assist commissioners of NHS 111 to develop clinical governance arrangements that support the delivery of a safe, clinically effective service which provides a positive experience for users. It contains a set of template documents and supplements the guidance provided within the NHS 111 Commissioning Standards.
NHS 111 CCG letter
NHS 111 quality and safety report
The NHS 111 Quality and Safety Report is a report of the review commissioned to assess and assure the quality of NHS 111 services during its early implementation phase from April to September 2013. It also looked at lessons that could be learned from the initial rollout stage. The review was led by Dr Mike Durkin, Director of Patient Safety for England. It suggests that people are generally having a good experience of NHS 111 services and it is providing a good quality and safe service to patients overall. Findings of the review also show that there is room for improvement, with some variation in the quality of services delivered. The service experienced many problems in the early part of 2013 with operational and staffing challenges leading to some delays in assessment and call back. The findings of the review will inform a programme of work to deliver safe sustainable services in the future and a sub-group of clinical leads has been established to take forward its recommendations. Many of the initial problems have been addressed and the latest data available.
NHS 111 commissioning standards
The NHS 111 Commissioning Standards sets out the standards and core requirements for NHS 111 services. NHS 111 is a vital service in helping people with urgent care needs get the right advice in the right place, first time. It is an important building block within the urgent and emergency care system, and supports patients navigate round what they tell us is a very complicated system. This free to use service is now available all over England, 24 hours a day, 365 days a year and call volumes are growing each month. The aim is to develop this service further and to respond to what people have told us, while ensuring that the safety and quality continue to be improved. The Commissioning Standards document is for CCGs, as commissioners responsible for NHS 111 and the performance of local urgent care systems, and has been jointly developed with them. The intent is not to prescribe how commissioners deliver these requirements but to ensure that patients can depend upon receiving the same high quality service wherever they live or access NHS 111 services in England.
There are a number of supporting documents to the Commissioning Standards which have been subject to further consultation. We aim to cascade these via the Regional NHS 111 leads by the end of November 2015. The regional leads include; Mark Bamlett, Mark Bounds, Helena Charlton, Aleksandra Connolly, Melanie De Smith, Phil Storr, Andy Summerbell, Eileen Sutton and David Walker.
VAT advice to providers and commissioners of integrated urgent care
The Integrated Urgent Care Commissioning Standards published in October 2015 outline the new model of integrated urgent care. Commissioners will need to take into account these commissioning standards when procuring new integrated urgent care services. NHS England recommends that expert VAT advice is sought prior to any procurement process to ensure that commissioners and providers are clear on the VAT implications of the locally determined contractual arrangement. Read the VAT advice to integrated urgent care providers and commissioners.