NHS Here for You: working differently to stay safe – Enhanced NHS 111 Service Stakeholder Update

November 2020

This is our third bulletin, raising awareness of the planned enhancements to the NHS 111
service.

Our EDs are beginning to see an increase in demand as winter pressures begin and the number of positive COVID-19 cases continue to rise within our region. From early December, NHS 111 will be able to directly book patients into time slots for Emergency Departments (EDs) and Same Day Urgent Care, when clinically appropriate. We’re working at pace to deliver this in line with the national ambition of December 2020 for
all trusts.

This need has always been present but has been brought into focus during the coronavirus pandemic. By triaging a greater number of patients through 111 first we can reduce unnecessary attendances at ED and help keep staff and patients safe in waiting rooms – maintaining social distancing during the COVID-19 pandemic. Importantly, our priority is to help people get to the right service for their needs.

We want to reassure people that nobody who attends an ED without having contacted NHS 111 beforehand will be turned away without support.

Clinically led approach

Demand and capacity data is being used to help shape and inform ED and Same Day Urgent Care clinical pathways, to meet the needs of patients. Our clinicians have reviewed and worked through a range of different conditions and
scenarios, to improve ED and Same Day Urgent Care services, to ensure patients can get directly to the service they need.

This means that patients might bypass EDs altogether if they are clinically assessed at NHS 111 as needing a Same-Day Urgent Care appointment. For example, a patient experiencing Deep Vein Thrombosis (DVT) symptoms will be given a timeslot direct into the DVT clinic. At the moment, they would be signposted to wait in ED, triaged and then sent onto the clinic to potentially have a further wait. By offering a timeslot, the patient will go straight into the relevant clinic, reducing waiting times and unnecessary steps in the patient’s journey.

In preparation for go-live, we aim to test direct access into Same Day Urgent Care clinics from mid-November onwards. We will be starting with a small number of pathways first, but hope to build on these if successful. We then hope to offer timeslots into EDs during early December.

A Quality Forum will be in place for clinicians, supported by the demand and capacity team to review and share data, metrics, and feedback. The forum will support clinicians, including representatives from Vocare (the local NHS 111 provider), to respond to any learning and inform future improvements.

Workforce

We continue to work closely with Vocare, who provide NHS 111 locally, to build in clinical
assessment for patients before they are offered a time slot. Following additional funding,
Vocare are continuing to recruit for call handlers and clinicians to support with the anticipated increase in call volumes.

Digital

Providers have been working hard to connect digital systems to enable direct bookings and ensure that patient information is transferred securely. During November, we will be testing our processes using a national system, with test patient cases, to ensure a seamless process for patients. As part of this, we are working with safeguarding and clinical teams to ensure this is not only a digital solution but where appropriate there is service to service handover.

Patient journey

Our aim is for more people to phone NHS 111, so that they can be directed to the right service for their needs and reduce unnecessary visits to EDs. If a patient does need to go to an ED or a hospital clinic, they will be given detailed instructions and a timeslot, following clinical assessment.

As happens now, all patients will be met by the triage team who will assess their needs and give further instructions. A timeslot is different to an appointment, and patients may still have a smaller wait, as the EDs will also have to prioritise critical cases that come in through ambulance or walk-in. However, we hope timeslots will help patients avoid peak times and where possible avoid longer waits, as can happen at the moment.

For patients who go to ED, and have not gone through 111, they will be assessed by the triage team and when ED is not the best place for their care, they will be safely signposted to other services including the urgent care centres/GP triage within hospitals. This already happens at the moment and we recognise that there is no one size fits all approach, every case is dealt with individually.

Over time, we hope to encourage more people to phone 111 first.

There will be a phased approach to communications, targeted to reach people who could have accessed alternative services to EDs if they had phoned NHS 111. The national communications campaign is due to launch in December and we will promote how people can use NHS 111 to access advice and to be signposted to the right place for their needs.

We continue to listen to the views of local patient groups to inform our approach to the enhanced service. So far, the feedback has been positive and the ability to receive an ED and Same-Day Urgent Care timeslot has been generally welcomed.

Next steps

We have made a lot of progress since our last bulletin, in establishing our local approach. There is more detail for us to work through over the coming weeks and we will aim to keep you continually updated with any developments.
For any further information on NHS111 First please contact twb.comms@nhs.net. If you would welcome a meeting to discuss this further, please let us know.