Transforming 111 to Integrated Urgent Care Keith Hardy NHS England (South East) 28/11/18

Moving NHS111 from “Assess and Refer” to “Consult and Complete”

Confidence in the system Background The patient wants Ease of access Seamless journey Minimal duplication Access to records Right place, right time Clear communication Confidence in the system 111 took 16.5 million calls last year 9.4% increase on previous year NHS Direct 5 million in final year 87% satisfied with the service 29% would have gone to ED if 111 not available confused mix for patients, clearly defined 111 as being central to delivery

Key Components NHS111 Call Handling A “Clinical Assessment Service” The introduction of an IUC CAS will fundamentally change the way patients access health services. It will mean patients will receive a complete episode of care concluding with either: advice, a prescription, or an appointment for further assessment or treatment with the call being closed within the service

The Clinical Assessment Service Five year forward view 2017 Integrated Urgent Care Service specification Key coordinating function Just the starting point Revolutionise the way urgent care services are provided and accessed 100% Clinical Assessment Service coverage March 2019 Striving for Consult and Complete

Urgent and Emergency Care System

ED GP 999 111

ED GP Pharmacy 999 Rapid response team Out of Hours Face to Face Urgent Treatment Centre 111

Chronic disease monitoring Mental Health team ED GP Pharmacy Community services 999 Supported discharge Rapid response team Out of Hours Face to Face Urgent Treatment Centre 111 Chronic disease monitoring

Clinical Assessment service Mental Health team Falls team ED GP Pharmacy Respiratory team Community services 999 Social Care Supported discharge Clinical Assessment service Frailty service Rapid response team Palliative team Home care Out of Hours face to face Paediatric services Urgent Treatment Centre 111 Chronic disease monitoring

National Specification The model for an IUC CAS requires the following offer for patients: access to urgent care via NHS 111, either a free-to-call telephone number or online; triage by a Health Advisor; consultation with a clinician using a Clinical Decision Support System (CDSS) or an agreed clinical protocol to complete the episode on the telephone where possible; direct booking post clinical assessment into a face-to-face service where necessary; electronic prescription; and self-help information delivered to the patient.

Examples from across the country Hertfordshire – with senior GP input a large majority of ambulance category 3 & 4 calls can be safely and appropriately moved within primary care/ Out of Hours Face to Face. Bath, Swindon, Wiltshire – Integrated co-produced service with commissioners - increased clinical support for paediatric patients built into specification as these patients reach high numbers of ambulance / ED dispositions. Phase 3 111 Online from Yorkshire delivering bookable digital appointments for dental patients

Questions?