1. NHS Pathways (Nov 2009) Dr Peter Fox Deputy Clinical Director
NHS Connecting for Health

2. Current NHS position Direction of travel for urgent care, DH 2006 Urgent Care Position Statement, RCGP 2007
Very different clinical triage processes depending on the setting
Patient and provider confusion
Niche products used to support triage e.g. ambulance dispatch, out of hours, NHS Direct
Many are built on US model of care and adapted for UK use
Systems do not communicate and limited success in attempts to bolt systems together – poor clinical continuity, duplication, inconsistency
Lack of a common content/variable outcomes/quality
NHS reliance on local standards, expertise and knowledge –national assessment and local referral difficult to harmonise
52% of the public unaware of out of hours services and do not know who to contact for urgent care
Worst scenario:- caller passed from pillar to post

3. Current ambulance service and out of hours model
Call handler
Model follows available ‘bolt together’ tools
Queuing, handover and retriage inevitable
No consistency of outcomes
High clinician dependency
High cost
Traditional telephone triage
Clinician

4. Everyone acknowledges but ….

5. The ideal…. Taking healthcare to the patient: Transforming NHS ambulance services, DH 2005 Urgent Care, RCGP position statement, 2007 Guidance And Competences For The Provision Of Services Using Practitioners With Special Interests RCGP, 2008
One common process of triage
One UK determined set of clinical content
One set of clinical performance measurement and management tools across different organisations
One approach enabling clinical data transfer between providers
One key tool to support commissioners of urgent and emergency care which also offers gap analysis
One accreditation and training package for users
Clinical content tailored to local delivery of the most appropriate skills in the most appropriate time frames
One system supports single point of access concept
One dynamic directory of service

6. Pathways telephone triage
NHS Pathways model
Common clinical content enables seamless links within and between services
Call handler role extended
Consistent outcomes
Consistent standards monitoring
Call handler
Pathways telephone triage
Clinician

7. Pathways – The clinical concept
NHS
For a given symptom, list the conditions that cause it
Assemble conditions into a hierarchy of risk
Progressively exclude the conditions considered by asking the minimum number of structured questions
Stop the process of triage when a condition cannot be excluded
Then refer the individual to a pre-determined clinical skill set and timeframe delivered by a locally determined provider
Offer tailored care advice to support the caller
Build in sophisticated reporting and QA tools
Aim use to be by specially trained call-handlers and clinicians
Support the whole with a high quality evidence base
Constantly review and upgrade

8. NHS Pathways – The operational model Appropriate care
Caller
999
Caller
Urgent
Caller
NHSD
NHS PATHWAYS clinical assessment
Clinical need and timeframe (plus postcode/age/gender)
Integrated Directory of Skills and Services
Appropriate care

9. Pathways – Linked Directory of Service
NHS

10. The dynamic directory of services
Pathways Disposition
Service capacity
Local options for delivery presented in commissioner agreed order
The dynamic directory of services

11. NHS Pathways – The DH Evaluation
(Janette Kay Turner, Professor Val Lattimer, Professor Helen Snooks)
“At least as safe as any similar system”
“Performs at least as well as any comparable system”
“A strength of NHS Pathways is the robust evidence base. A long term aim should be to develop a systematic method and process to ensure this evidence base is kept up to date”

12. Cohorts of new users
Operations reporting

13. PERFORMANCE RESULTING IN 999 DISPOSITIONS
Individual reporting

14. Pathways – Maintenance?
NHS
“A strength of NHS Pathways is the robust evidence base. A long term aim should be to develop a systematic method and process to ensure this evidence base is kept up to date” (Jeanette Turner)

15. Pathways – National Governance Group
NHS
The RCGP will lead the national governance group of colleges and key organisations
The group will oversee the clinical content development of NHS Pathways as a common telephone triage system for the NHS.

16. NHS North East Ambulance Service County Durham & Darlington SPA
Pathways – Where in use?
NHS
North East Ambulance Service
County Durham & Darlington SPA
Fylde Coast Medical Service

17. Pathways – Where next?
NHS
NHS Direct
3DN Pilots
Other OOH Services

18. NHS System – eg Cleric, Adastra, TPP End User - Service Training
Pathways – Licensing
NHS
System – eg Cleric, Adastra, TPP
End User - Service
Training
Cost – Pathways content free

19. NHS Pathways (Nov 2009) Dr Peter Fox Deputy Clinical Director
NHS Connecting for Health