1. 22 July 2019
NHS 111
[Document title]

2. Confusing and piecemeal system
22 July 2019
Confusing and piecemeal system
Who are you going to call? Where should I go?
999?
NHS 111?
A&E, or MIU, UCC?
Out of hours GP?
[Document title]

3. Vision for NHS 111 and urgent care
22 July 2019
Vision for NHS 111 and urgent care
NHS 111 and urgent care together
A service that is Less confusing, Quicker, Easier to use and Joined up
24/7 Integrated Urgent Care access, treatment and clinical advice service working together with ‘all hours’ GP services:
Build on NHS 111 to simplify access for patients to urgent care
An integrated 24/7 “front door” to the NHS urgent care service
NHS 111 GP Out-of-hours services, community services, ambulance services, emergency departments and social care.
NHS 111 as the single entry point
organisations collaborate to deliver high quality, clinical assessment, advice and treatment
Central to this will be a ‘Clinical Hub’
access to a wide range of clinicians, both experienced generalists and specialists.
Able to share information where appropriate and we have your consent
[Document title]

4. Local engagement so far
22 July 2019
Local engagement so far
You said – key themes from focus groups meetings
Access
One call wherever possible
Only tell my story once
Direct transfer to pharmacist or dentist
Technology
With your consent, everyone has the right information for your care
Seamless transfer from one service to another – no repeating of my story, no waiting
Cloud based computing
Workforce
Direct referral to the right clinician or healthcare professional
Communication
Wide scale education and communication campaign
Service Integration
Joined up NHS 111, out of hours and urgent care
Funding allocated where it is needed to support new services.
[Document title]

5. Local engagement so far
22 July 2019
Local engagement so far
You said – larger public event key themes
People with learning disabilities/hearing impairment/lack of sufficient knowledge of English are not accessing the service. How will this be facilitated?
Important to communicate new service to patients effectively/education campaign
More links and signposting to other services – including third sector (child line, silver line), social care, palliative care, Police and Samaritans
Set up a patient group to review and check calls and development of specification
Mental health – ensuring people get appropriate care
Special patient notes – how will everyone who needs to see special patient notes have secure access to them?
How will it improve in particular care for illnesses such as sepsis and meningitis?
[Document title]

6. 22 July 2019
How it’ll work locally
We’re doing
People with hearing impairment, learning disabilities or who need a translator
Translator must be available within 15 minutes.
Staff trained to handle calls properly from people with hearing impairment.
National deaf service for NHS 111
We’ll book an appointment or transfer to the right person
We’ll review the service – play back calls etc. are built into the specification
We want your help to improve – patient reference group and further engagement will take place
Accessible Information Standard – new contractual requirement for all NHS providers
[Document title]

7. Vision for urgent care NHS 111
22 July 2019
Vision for urgent care
A simplified diagram of how it will work
NHS 111
Clinical Advice and Treatment Service (CATS)
Clinical Assessment and referral
Home Visit
Urgent Care Centre/WiC/GP Access
999/ED
Self Care
Appointment made directly in Primary Care
Single Point of Access
[Document title]

8. Vision for urgent care Warm transfers and assessment call backs
22 July 2019
Vision for urgent care
What will the Clinical Hub do?
Warm transfers and assessment call backs
Localised Clinical Assessment
Self-care advice
Appointments at Walk in Centres
Appointments to Urgent Care Centres
Appointments at the GP practice
Referrals and tracking to single or multi providers
Integration with community services
Out of Hours Home Visiting
[Document title]

9. What needs to be clearer?
22 July 2019
Over to you
Group discussion
What have we missed?
What needs to be clearer?
What would give you greater confidence to follow NHS 111 advice?
[Document title]

10. 22 July 2019
Tom
Raging toothache
Tom is a 29 year old factory worker with raging toothache. He doesn’t have a dentist and hasn’t been seen by a dentist since he was a teenager. He has been trying to ignore background toothache he had been experiencing for over a week, wondering how to contact a dentist. In the early hours of Saturday morning he wakes with raging toothache, he takes two paracetamol but it’s not even touching the pain, he lives with his girlfriend who advises Tom to call NHS 111 to call NHS 111
Access
Tom is immediately given the option to be put straight through to a dental nurse. The dental nurse will assess Tom’s toothache and give him advice.
He is linked to a pharmacist who prescribes him pain killers & antibiotics over the phone.
He is given an appointment with an emergency dental appointment within 12 hours.
Technology
The Directory of Services allows them to find Tom the nearest available emergency dentist to his home and can book an appointment directly with that surgery.
Tom receives a text from NHS 111 with all of the details of this appointment including how to get there.
Workforce
Tom speaks directly with a dental nurse who can give him the specialist advice he needs.
The pharmacist is also able to prescribe him medication and informs Tom of nearest open pharmacy.
[Document title]

11. 22 July 2019
Maryam
Complex history including diabetes
Maryam is an 87-year-old who lives on her own. She has a complex medical history including diabetes, COPD and she relies on the support of her carers who visit her four times a week. Her daughter Sarah lives 100 miles away and checks in on her by telephone intermittently. Maryam has sudden health problem. Sarah rings on a Saturday morning at 10am but Maryam fails to answer the telephone. Sarah telephones a neighbour Justine, who finds Maryam spent the night in her living room sofa without taking her medication. Saturday 10:00am: Sarah agrees with Justine, the trusted neighbour that she should ring 111 with Maryam beside her.
Access
Justine, the neighbour is able to speak to NHS 111 on Maryam’s behalf.
NHS 111 are able to carry out the crises section of her care plan and send out the appropriate response team to her home.
Once the acute problem has been resolved Maryam is re-assessed to determine the cause of the exacerbation of her condition. Her care plan is updated.
Technology
NHS 111 staff have access to Maryam’s care plan. This contains the number of regular carers and times at which they visit.
The directory of services contains a rapid response team number for her area if the usual carers are unavailable.
Maryam’s daughter is registered as next of kin, so NHS 111 sends an automatic text to her mobile phone.
Workforce
The NHS 111 staff use the NHS pathways tool to guide them and are able to calm the anxiety of Maryam and Justine.
A health advisor is able to access Maryam’s care plan and engages relevant other teams where needed.
Depending on the severity of Maryam’s acute problem she might need a home visit from a care co-ordinator, nurse, GP or paramedic.
[Document title]

12. 22 July 2019
Asif
End of life care
Asif is a 73-year-old gentleman who lives with his wife. Asif was diagnosed with terminal lung cancer six weeks ago after many months of radio and chemotherapy treatments. Melek and Asif have discussed with their GP that Asif wants to stay at home for the remaining weeks of his illness and die at home surrounded by his family, they have two sons and several grandchildren who live nearby and pop in regularly to support. Asif’s GP has completed a CMC care plan with him and Melek discussing remaining treatment options, symptoms they should expect and palliative medication to control these symptoms. Asifhas a sudden deterioration. Melek is finding it hard to rouse and look after Asif. Anxious and upset, she calls her sons and NHS 111.
Access
Asif’s CMC plan states that he wants to die at home.
NHS 111 are able to alert his Palliative Care team very quickly that he needs urgent care.
If they are unable to attend urgently they will contact his GP to arrange a home visit.
NHS 111 contacts the nominated family member
Technology
As Asif is on an end of life care plan, NHS 111 are able to see this electronically and are alerted straight away. This changes the questions asked.
A notification is sent electronically to Asif’s palliative care team to alert them that he needs urgent support.
A notification is also sent to Asif’s GP
Workforce
While the palliative care team are travelling to Asif, the NHS 111 staff stay on the phone to Melek to reassure her.
On arrival, the palliative care nurse assesses Asif’s condition and revises his medications including pain control and breathing management.
[Document title]