CLINICAL GOVERNANCE OF HEALTH ADVISORS Tricia Hamilton, RN BSc (Hons) Regional Director of Nursing North West Region

NHS DIRECT CORE SERVICE  There is a choice of ways to access NHS Direct:  via the internet at  on digital TV - press the ‘Interactive’ button on your Sky Digital remote control and scroll down to NHS Direct Interactive or go to Channel 108 on Freeview.  by telephoning  Different audiences e.g. social class C 2 DE use digital TV  Interpreting service and textphone service  Available 24/7

NHS DIRECT TELEPHONE SERVICE Background  Currently delivered from 9 regions (correspond to SHA’s) operating as a virtual contact centre  Delivered by health advisors, nurse advisors (including dental nurses) and health information advisors  Handles a wide range of calls including:  what to do when feeling ill  information on local health services  advice on maintaining a healthy lifestyle  information about illnesses, conditions, tests, treatments and operations  complex enquiries about medication  information in response to national health scares.

RECRUITMENT OF HEALTH ADVISORS  NHS Direct undertakes a rolling programme of recruitment  Full training is undertaken via a 3 week induction programme which includes:  Risk Management  Critical thinking  Child Protection/vulnerable adults  SCAN (mental health training)

RECRUITMENT OF HEALTH ADVISORS  Staff supported through period of mentorship  Supported by Team leader and Clinical Team Leaders available 24/7  Use a ‘Call Streaming and Prioritisation Tool’ to support and guide the initial assessment and prioritisation of calls  Priority 1 calls – ‘live’ transfer to nurse advisor  Priority 2 calls – assessed by a nurse in 1 hour  Priority 3 calls – completed in 3 hours

PERFORMANCE MANAGEMENT  Health Advisor can review their own practice via an Individual Performance Reporting Tool (IPRT)  Meet with line managers on a 1-2-1basis every 6 weeks to discuss performance  Open culture of reporting incidents internally and externally via health professional feedback, complaints and compliments  Supported by national policies and procedures

INVESTIGATION AND LEARNING  Open culture of incident review through individual call reviews  Peer review at a national level of untoward incidents  Open learning culture and shared learning with external stakeholders  DH targets for handling of complaints and incidents

CALL REVIEW TOOL

Orientation Phase 1.Opens call appropriately 2.Immediately establishes control of the call gaining cooperation with the call handling process 3.Rapidly checks for the presence or absence of life threatening symptoms taking action where appropriate 4.A communication dialogue is quickly established that enables a call reason to be agreed Breakdown of Orientation Score

Identification Phase 1.Selects the most appropriate Symptom Protocol for the caller or records reasoned rationale for bypassing or early exit. 2.Progresses logically through the symptom protocol using cues and information to complete all fields correctly. 3.Assigns an appropriate priority/outcome. Breakdown of Identification Score CALL REVIEW TOOL

Exploitation Phase 1.Establishes an accurate and currant record for the patient 2.Maintains confidentiality at this point and throughout the call 3.Adapts communication and call management techniques to the caller throughout including where appropriate managing distressed, challenging or frequent callers 4.Multi tasks throughout, maintaining call flow and control and where relevant using call back or call hold efficiently in negotiation with the caller CALL REVIEW TOOL

Exploitation Phase 5.Adheres to additional national and local policies and guidance throughout call handling stage 6.The call and information was safely transferred to the correct end point with worsening and call back instructions given as required, or responds effectively to simple information requests from the caller 7.Completes the call record, recording only pertinent information that complies with documentation guidance Breakdown of Exploitation Score CALL REVIEW TOOL

Resolution Phase 1.Works within role boundaries and limits of competence seeking guidance from senior colleagues appropriately. 2.The call was timely and appropriate to the caller’s needs Breakdown of Resolution Score Summary of Totals Total Score Total Score as a Percentage CALL REVIEW TOOL

 Feedback can be sent to  Any questions