NHS 111 Lessons Learnt & Shared understanding – Guidelines and information
NHS 111 Programme
Version 1.2
September 2011
Document control
Audience / NHS 111 Programme and NHS 111 Pilot TeamsDocument Title / NHS 111 Lessons Learnt and shared understanding guidelines and information
Document Status / Version 1.1 of the Lessons Learnt approved for use.
Document Version / 1.2
Issue Date / 27th September 2011
Prepared By / NHS 111 Operations Manager
Version / Date / Name / Comment
0.1 / 27/06/11 / Diane Baynham / First draft circulated for comment
0.2 / 04/07/11 / Diane Baynham / Added content and further lessons learnt.
0.3 / 07/07/11 / Diane Baynham / Incorporated comments and further lessons learnt.
0.4 / 15/07/11 / Diane Baynham / Addition of appendix and links
1.0 / 08/08/11 / Diane Baynham / Approved version including new and updated lessons learnt, reformatting and updated appendix.
1.1 / 22/08/11 / Diane Baynham / Updated & new lessons learnt
1.2 / 27/09/11 / Diane Baynham / Updated & new lessons learnt
- Lesson 20 (amended wording)
- Lesson 21 HPA requirement
Contents
Document control 1
Contents 2
1 Summary 4
2 Introduction 5
2.1 Purpose 5
2.2 Audience 5
2.3 Status 5
2.4 Related documents 5
2.5 Structure 5
3 Overview of the NHS 111 service 6
3.1 Introduction 6
3.2 Vision 6
3.3 How will 111 work? 6
3.4 Core principles 6
3.5 Benefits 7
4 Lessons related to NHS 111 vision 9
4.1 Introduction 9
4.2 Lesson Learnt #1 9
4.3 Lesson learnt #2 9
4.4 Lesson learnt #3 11
4.5 Lesson learnt #4 11
4.6 Lesson learnt #5 12
5 Lessons related to training 13
5.1 Introduction 13
5.2 Lesson learnt #6 13
5.3 Lesson learnt #7 13
6 Lessons related to performance 16
6.1 Introduction 16
6.2 Lesson learnt #8 16
6.3 Lesson learnt #9 16
6.4 Lesson Learnt #10 16
6.5 Lesson Learnt #11 16
7 Lessons related to testing 17
7.1 Introduction 17
7.2 Lesson learnt #12 17
8 Lessons related to Operational Planning 18
8.1 Introduction 18
8.2 Lesson learnt #13 18
8.3 Lesson learnt #14 18
8.4 Lesson learnt #15 18
8.5 Lesson learnt #16 19
8.6 Lesson learnt #17 19
8.7 Lesson learnt #18 19
8.8 Lesson learnt # 19 20
8.9 Lesson learnt # 20 20
8.10 Lesson learnt #21 20
Appendix 21
1 Example Patient journey 21
2 Example area thinking for benefit realisation 26
3 Example daily Call profile 30
4 Example Call modelling 31
NHS 111 Lessons Learnt v1.1 Page 3 of 33
1 Summary
This document brings together insights into lessons learnt by NHS 111 pilots and sits alongside specific learning’s that may have been undertaken within formal project phases of any pilot area.
This document presents areas of recommended good practice. It is not intended to replace any learning collected within the pilot phase nor does it replace the lessons learnt activity specific to evaluation activity.
The aims of this document are to:
· To provide information on an aspect that may have changed or challenged previous pilots.
· To support any reflection taking place during development for next phase pilots.
· To prompt thought or remedial action for aspects not previously considered for next phase pilots.
· To provide ideas for solutions previously applied or considered.
This document is a living document; active lessons may be included from pilots at any stage of their rollout. This document will be reviewed bi-monthly and any lessons updated. Lessons Learnt documentation will be overseen via the NHS 111 Operations Group.
2 Introduction
2.1 Purpose
This document is intended to provide guidelines, prompts and information on implementing the NHS 111 service. Note no single approach is mandated.
2.2 Audience
This document is intended to be used by the new NHS 111 pilot areas to help inform their implementation work of the NHS 111 service.
2.3 Status
This document is agreed by the NHS 111 Operations Group as an iterative document. This document is available for use.
2.4 Related documents
This document forms part of the Service Readiness Toolkit and should be read in conjunction with the following documents:
· 111 Service Specification
· NHS 111 Core Script
· NHS 111 Introduction
· Review of the Clinical Governance of an NHS Service
· NHS 111 Toolkit, which includes:
— 111 Special Notes Distribution Guide
— Telephony Guide for NHS 111
— 111 Service Readiness Process Guide
— NHS 111 Interoperability Specification
— NHS 111 used case guide
2.5 Structure
Overview of the document, summarising each section:
· Section 3 – Overview of the NHS 111 Service
Sets out the vision of the NHS 111 service providing the context for the lessons outlined.
· Section 4 – Lessons related to the NHS 111 vision
Sets out identified lessons relating specifically to the interpretation of the NHS 111 vision.
· Section 5 – Lessons related to the NHS 111 training
Sets out identified lessons relating specifically to the planning and delivery of training.
· Section 6 – Lessons related to Performance
Sets out identified lessons relating specifically to delivery and development of the NHS 111 service against quality and performance measures.
· Section 7 – Lessons related to testing
Sets out identified lessons relating specifically to the testing and service readiness for any go live of the NHS 111 service.
· Section 8 – Lessons related to operational planning
Sets out identified lessons relating specifically to the operational planning and development of the NHS 111 service.
· Appendix 1 – Example service design of a patient journey
· Appendix 2 – Example areas for potential benefit realisation
· Appendix 3 – Example daily call profiles
· Appendix 4 – Example Call Volume Modelling
3 Overview of the NHS 111 service
3.1 Introduction
This section provides an overview of the NHS 111 programme, setting out; the vision, describing how it will work, the core principles of the service, and the expected benefits of the NHS 111 service.
3.2 Vision
NHS 111 TRANSFORMING ACCESS TO URGENT HEALTHCARE
The NHS 111 service will make it easier for the public to access urgent healthcare and will drive improvements in the way in which the NHS delivers that care.
3.3 How will 111 work?
NHS 111 is being introduced to make it easier for public to access urgent healthcare services.
The free to call 111 number is available 24 hours a day, 7 days a week, 365 days a year to respond to people’s healthcare needs when:
· you need medical help fast, but it’s not a 999 emergency
· you don’t know who to call for medical help or you don't have a GP to call
· you think you need to go to A&E or another NHS urgent care service
· you require health information or reassurance about what to do next
Callers to 111 are put through to a team of highly trained call advisers, who are supported by experienced nurses. They use a clinical assessment system and ask questions to assess callers’ needs and determine the most appropriate course of action, including:
· callers facing an emergency will have an ambulance despatched without delay;
· callers who can care for themselves will have information, advice and reassurance provided;
· callers requiring further care or advice will be referred to a service that has the appropriate skills and resources to meet their needs; or
· callers requiring services outside the scope of NHS 111 will be provided with details of an alternative service.
The NHS 111 service also provides management information to commissioners regarding the demand for and usage of services in order to enable the commissioning of more effective and productive services that are designed to meet people’s needs.
3.4 Core principles
NHS 111 operates according to the following core principles:
· Completion of a clinical assessment on the first call without the need for a call back
· Ability to refer callers to other providers without the caller being re-triaged
· Ability to transfer clinical assessment data to other providers and book appointments where appropriate
· Ability to dispatch an ambulance without delay
These are the fundamental requirements that underpin the NHS 111 service.
3.5 Benefits
The introduction of the new NHS 111 service is expected to provide key benefits to the public and the NHS, by:
· Improving the public’s access to urgent healthcare services:
— Providing a simple, free to call, easy to remember three-digit number, that is available 24 hours a day, 365 days a year; and
— Directing people to the service that is best able to meet their needs, taking into account their location, the time of day of their call and the capacity of local services.
· Increasing the efficiency of the NHS:
— Providing consistent clinical assessment that ensures people access the right service, first time;
— Directing people to the service that is best able to meet their needs; and
— Rationalisation of call handling.
· Increasing public satisfaction and confidence in the NHS:
— Improving the public’s access to urgent healthcare services:
— Providing an entry point to the NHS that is focused on peoples’ needs;
— Enabling people to access the right service, first time; and
— Increasing efficiency of the NHS by directing people to the service that is best able to meet their needs.
· Enabling the commissioning of more effective and productive healthcare services that are tuned to meet people’s needs:
— Identifying the services, which are currently over or under used;
— Providing information on people’s needs and the services they are directed to; and
— Increasing understanding of the shape of demand for each service.
· Increasing the efficiency of the 999 emergency ambulance service:
— Reducing the number of non-emergency calls received by 999; and
— Reducing the number of avoidable ambulances journeys.
4 Lessons related to the NHS 111 vision
4.1 Introduction
A key starting point emerging from all of the pilot areas, is that the NHS 111 programme specification does not contain the detailed requirements to enable a solution to be defined or a service to be procured against.
4.2 Lesson Learnt #1
The NHS 111 Service specification holds only the vision and key areas that feature within the vision of NHS 111. Each commissioner should consider how they want the service delivered in their local area; scope and depth will need to be defined including the interoperability and information flows between systems. Each service is likely to have unique features though there will also be commonalities that capture the vision of NHS 111.
NHS 111 can be designed locally to reach far beyond the initial vision; this is a locally led solution and is not limited to the key areas within the NHS 111 service specification; Commissioners should consider system redesign where required.
You should engage with GP’s and other 3rd parties from the outset. This area was identified as crucial within the initial evaluation through Sheffield University[1] who indicated there should be a passenger list of all groups and organisations that should be included from the outset rather than at a later stage.
4.3 Lesson learnt #2
It is essential that that all partner organisations within the pilot, GP’s and other clinical colleagues are 100% on board with the pilot; you should not assume any prior understanding of the NHS 111 requirement or vision.
Local health economy ownership of the end to end patient pathway is absolutely essential and without such engagement the pilot is unlikely to achieve the NHS 111 vision preventing go live and more critically, will not realise the local economy benefits that are desired.
In pilot areas where this aspect has not been adequately embedded, issues have arisen and patient journey reviewed to meet requirements post implementation as a result; if major changes are required this could result in additional cost, difficulty in change management and credibility issues - early and frequent engagement and clinical sign off can-not be over emphasised.
You should consider the following strategies for wider engagement within areas alongside your own:
· Engagement with 3rd parties should be ongoing and at a very detailed level. Detailed work across stakeholders demonstrating the patient journey, re-engineering seamless transactions, engaging on system reform and ownership throughout the system.
· Hold stakeholder workshops demonstrating the clinical algorithms and the process for call assessment. Undertake mock calls to enable stakeholders to understand the process and outcomes for the patient.
· Arrange for stakeholders to listen and review calls with other NHS 111 areas; consider undertaking a comparison of the current patient pathway to demonstrate value.
· You should ensure participation of all PCT’s (and commissioning consortia) in the region to strengthen focus, develop next wave understanding and create a provider network. Relationships and partnership working are absolutely key in the realisation of the NHS 111 vision.
· You should consider re-commissioning or re-negotiating service contracts where required; ensuring partnership working through the whole system in order to realise the benefits of NHS 111.
· You should make visits to individual General Practice. It has been demonstrated as best practice to sit with GP’s individually to ensure engagement and full visibility of the vision for NHS 111. Without such engagement there is potential for miscommunication and misinterpretation of the NHS 111 pilot.
· Early engagement of GP Receptionist within surgery is key to enable access to GP’s and also to encourage communication regarding NHS 111 for surgery staff.
· Pharmacy and District Nurses should have specific visits or communications by PCT 111 staff to ensure awareness of system re-engineering and their part in redesign.
· 111 Project Board places should be representative of the stakeholder map. Partners should be included around the table and should be equal where there are multiple providers; this includes the ambulance service in each area. This will enable the breaking of historical boundaries and creation of new relationships allowing cross boundary working.