Pandemic Flu: A perspective from NHS Direct and the National Pandemic Flu Service Ronnette Lucraft Commercial Director, NHS Direct, and Operations Director, NPFS 26 November 2009

Agenda NHS Direct’s role in Pandemic Flu preparedness and response Objectives of the National Pandemic Flu Service The interface with Emergency, Urgent and Primary Care Usage and patient feedback Differences between the Interim and Strategic systems What next?

NHS Direct’s role in Pandemic Flu preparedness and response Multi-channel info and advice National resilience to support local hotspots Encourage self care when appropriate Lend experience and know-how for the establishment and operation of NPFS

Objectives of the National Pandemic Flu Service assist the right people to get the right treatment, at the right time enable those who have flu to stay at home help manage the impact of flu on the wider NHS protect the stockpile of antivirals and support a fair and equitable release

Hello… welcome to National Pandemic Flu Service 2 Hello… welcome to National Pandemic Flu Service 2. Assess 1 1. Contact National Pandemic Flu Service Click next for assessment Antiviral Collection Point National Pandemic Flu Service FluLine 3a. Authorise Authorisation Number: URN: 4. Collect NJFL 9857 123 9857 3b. Hand-off National Pandemic Flu Service Click next for assessment 3c. Advice Drink lots of water…

Go Live Summary At Go live the NPFS had: 3500 agents trained and ready to take calls in 19 centres, operating from 8am to midnight A web service available on www.direct.gov.uk/pandemicflu A recorded information line A network of Anti-viral collection points Clinical liaison in partnership with the RCGP

The interface with Emergency Care Initial questions to identify life threatening conditions which require an emergency response. Changing words have changed referral rates without compromising patient safety Considerable effort with the call centre agents to ensure that they are not “leading” the patients Before we begin the assessment for flu, we need to check if the patient needs an emergency ambulance Before 10 - 12% Before we assess the patient for swine flu, we need to ask two questions to check whether the patient needs hospital care now. If the patient answers 'yes' to one of these questions you will be advised to call 999 immediately and we will not go on to do the flu assessment, as this could delay urgent treatment. After 5 - 6%

The interface with GPs and OOH Questions within the algorithm determine whether the patient is referred to primary care for additional assessment and treatment This applies to: all patients under one year old Pregnant women Renal patients high risk groups Those with additional symptoms – complications Work is on-going with the DH and RCGP to ensure that referrals are appropriate the messaging at GP practices is consistent OOH providers are briefed

NPFS Usage Cumulatively from Thursday 23 July to Tuesday 17 November 2.25m assessments have been completed 1.53m URNs have been issued 950k AVs collected. Circa 40% of assessments have been completed on-line

NPFS Usage – by time of day and day of week The peak hour of callers to the NPFS is between 9and 10am on Monday mornings The service is used considerably more during the in-hours rather than OOH period Calls delivered to NPFS call centres, w/c 2/11/09

NHS Direct impact The launch of the NPFS had a real impact on the number of callers to NHS Direct Telephone calls answered by NHS Direct Callers recently seem to have a higher level of acuity, and there are more symptomatic patients rather than information seekers Weekends and OOHs continue to be the busiest times

NHS Direct impact (2) The NHS Direct web services helped it to deal with a high proportion of enquiries An average of 7k uses of the Colds and Flu symptom checker per day Peak of usage of 175k in one day Over 10m page views on NHS.uk and NHSdirect.nhs.uk since 27th of April

Patient feedback on the NPFS As of the end of October, there had been 31 formal complaints There has also been a number of pieces of informal feedback Topic Number ACP issues 243 Website issues 238 Callcentre Issues 108 Other parts of NHS 60 We have also received a number of compliments

Key functional differences between the Interim and Strategic systems Use of Health Number and associated look up systems URNs can be re-issued 6 Languages for web- English, Welsh, Portuguese, Polish, Turkish and Russian IVR Targeted and Treat-all algos NPFS Professional Web based MI There are no current firm plans to mobilise the strategic solution during this pandemic

What next? The second (and third?) wave and interplay with seasonal flu Very difficult to forecast! Planning for the switch off and dormancy of the NPFS is underway