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

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

4. 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

5. 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

6. 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

7. Urgent and Emergency Care System

8. ED GP
999
111

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

10. 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

11. 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

12. 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.

13. 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 Online from Yorkshire delivering bookable digital appointments for dental patients

14. Questions?