The Workshops Were Held Across 3 Locations in Thames Valley

Appendix 3 - Workshop Analysis

Summary of Workshops

The Workshops were held across 3 locations in Thames Valley:

Location / Date / Status / Attendees
Conference Room A and B, Jubilee House, John Smith Drive, Oxford. OX4 2LH / Thursday 23rd July 2015
5.30 – 7.30pm / Complete / 18
Boardroom, King Edward VII Hospital, St. Leonards Road, Windsor, Berks. SL4 3DP / Wednesday 29th July 2015
4.30 – 6.30pm / Cancelled to be rescheduled for mid-September
57-59 Bath Road, Reading, RG30 2BA. Room G29/30 / Thursday 30th July 2015
7.00 – 9.00pm / Completed / 16
Aylesbury Vale CCG Boardroom, The Gateway, Gatehouse Road, Aylesbury, HP19 8FF / Friday 31st July 2015
1pm – 4pm / Completed as in-depth interview / 2
Albert House, 2nd floor, Queen Victoria Road, High Wycombe, HP11 1AG / Tuesday 29th September 2015
6pm – 8pm / Complete / 3

2. Demographics

Patients were all from the Thames Valley area. There was a spread of those involved, from patients who had had significant involvement in the NHS and NHS111 previously and those that were less familiar with the structure of engagement and the NHS.

A summary of those involved

Practice Manager
Unison Representative
Healthwatch (member of Board of Directors)
Paediatric A&E Registrar
Chair of Patient Voice
Practice Patient Participation Group Member
Retired Mental Health worker
Member of the CSU Comms Team
Governor of Mental Health Trust
Governor of Out of Hours service
Parliamentary Press Secretary
2 x 12 year olds with parental supervision
Carer

The age range of the workshops was between 12 – 87 years of age.

3. Workshop Structure

Details of the Workshop Structure are within Appendix 4, which includes the presentation used at all workshops.

The workshops included a blend of presentations and discussion opportunities. The group was positioned into working groups and given specific topics to discuss and feedback to the facilitators. The workshops also included a demonstration of NHS Pathways.

3a. Ice Breaker

We asked the group the following questions and asked to present to the rest of their table top group:

•Name?

•Where you live?

•What is your ‘relationship’ with the health service? i.e. member of PPG, Long term condition

•How do you currently deal with health enquiries about you or your family? i.e. GP, consultant appointment, online, pharmacist etc.

•What you want to get out of or input into this evening?

Comments during Ice Breaker Introduction

1)I don't use the internet, you don't know how reliable it is

2)Why would you go to a pharmacist for advice?

I’ve had a good experience of NHS111 and it helped me when I need it
People don’t know what NHS111 is

3)My pharmacist is great for advice. In other countries where care is not free at point of delivery, pharmacists are regularly consulted by people who need advice

4)Face to face appointments are essential because it allows a professional to sift through key information to identify issues, which cannot be done over the phone

I’m not so sure about how much pharmacists are used, I would like to see my GP and I wonder how much they are getting paid to take on additional activity

5)I have had the same GP for 30 years. It is important to see someone who knows me (and my history) well

6)The challenge with the 111 logo is the word ‘urgent’. When you’re in distress, everything is urgent.

7)I go to where I can cause the least problem to anyone

8)The facilities available locally really affect how services are accessed (rural vs urban)

9)I wouldn't use an online service as I want to know who is giving me information

10)Patients in Oxfordshire used to have the choice to dial OOH or NHS 111. Now this choice has been taken away without patient consultation

11)My GP is very difficult to access

12)NHS111 isn’t well known and should be advertised

13)Experience of 111 was very robotic

14)Did not get the advice I needed using NHS 111, found the answer on the internet and got what I needed at high street store.

3b. Benefits and Limitations of NHS111

The workshops were asked to split into their groups and the facilitators scribed the group’s thoughts and discussion points.

Benefits / Limitations

Easy to access
Good access
Active listening
Suitable for older generation (telephone)
Access to 999 (direct dispatch ambulance)
Triaging patients to the most appropriate place
Good public health education
National Standards
Reassurance
Immediate access (if not an emergency)
Convenience in OOHs (24/7 access)
Economical benefit to the NHS
Joined up service (integration) information and advice
Front door access (less confusion)
Ability to further clinical enhance the service (Mental Health)
Quick response
111 number free
Information centre
Equality of access
Quick assessment (should get)
Refuse dispositions automatically
going to clinician is positive
Access from home

Paediatrics pathways limited
Trigger questions after demographics too late

Not an app
Risk averse
Dementia patients may find access to the service challenging –what support does it offer?
Health information limited
Integrate with 101.
Access to patient records (amenity)
Access to community Health services
Access to Mental Health Services
Midwifery
Paediatrics
101 and NHS111 causes confusion
Not clinical advice
Who transferred to?
Difficult to get transferred on
Only as good as the DoS
Delays in onward care
Delays in delivering aftercare
Links to other services
Communication of the service means that patients don’t understand it
If you know what you want – questions irrelevant

3c. Developments to the NHS111 Service

The groups were introduced to a series of potential initiatives or future developments to the NHS111 service. These were explained and detail given, especially if the initiative has been piloted or exists in an NHS111 service nationally then detail was given.

The groups were invited to ‘vote’ for what they considered to be their favourite or most important development:

Online Symptom Checker / Direct Referral to a Local Pharmacist (who knows your details when you arrive) / NHS111 App available on Smart Phone
Access to My Medical Records / Pharmacist in the Call Centre / Enhanced Mental Health Specialism within the Call Centre
Online NHS111 Access / Web Chat with a clinician / GP In the Call Centre
Access to a GP Appointment / Video Calling with a Clinician / NHS111 Call Handlers carrying outbound ‘Touchbase’ calls to vulnerable patients

Chart to demonstrate how patients expressed their preference in future initiatives

Initiative v. number of ‘votes’

3d. Of note

GP In the Call Centre

There was some concern over the level of clinical intervention in NHS111 and patients were wholly supportive of more GP involvement. However there was a level of responsibility in this as the group recognisedthat there was limited resource available. The idea of linking this into existing GP In and Out of Hours services was supported.

Online NHS111 Access

Patients thought this was a natural development as long as this did not replace the existing service.

NHS111 App available on Smart Phone

This was a popular initiative with those that grasped and embraced technology. These patients supported how easy an App would be to access and how it could already have your details loaded in.

Some patients also supported the idea of an App for other areas of the NHS ie maternity and links to Health Visiting and Midwifery support as well as Long Term Condition Management for the younger generation.

Web Chat with a clinician

Access to a GP Appointment

When the concept of directly booking into a GP from 111 was discussed it was met with mixed responses. Many patients were able to book their own GP appointments online, as they had registered with their GP to an online service provided by their practice. This cohort seemed open to the idea of NHS111 booking into GP Practices on behalf of patients – largely because they knew they had access themselves so didn’t see any issue with NHS111 doing it after NHS Pathways had been followed.

Access to My Medical Records

There was support for this initiative but only for clinicians to view their records.

Video Calling with a Clinician

Enhanced Mental Health Specialism within the Call Centre

Patients considered this to be a very good idea. The model employed in the West Midlands was explored and described, this involves Community Psyciatric Nurses being placed in the NHS111 Call Centre evenings and weekends to support calls from patients with a specific mental health need.

NHS111 Call Handlers carrying outbound ‘Touchbase’ calls to vulnerable patients

The reaction to this was split with some patients incredibly supportive of using the NHS111 in its less busy periods to outbound call to patients for medication reminders, welfare checks and comfort calling. Others felt this was a Social Care responsibility and they perceived that if NHS111 were unexpectedly busy then this this might not happen putting a risk to the patient.

3e. Group Ideas

The groups were also prompted to think throughideas for the service that they had themselves. These are the ideas that were discussed or submitted.

Better checks made on doctors who are sent out to homes from 111 calls
More publicity for the service and this it is 24 hours
More publicity and clarity about NHS 111 (Public ignorant at present)
Suicide risk assessment
Trained ‘listeners’ to offer an ear to the “worried well”
Better, more comprehensive information about ‘what is’ and ‘what is not’ NHS 111
Educate public as to what the key questions are that will be asked on the call process will be more efficient.
Joint contract with OOH as a system support
Use 111 as badly needed communication service including GP
Do not use non clinicians to give guidance, unthinkable it should be done by GP receptionist
The approach manner of the call handler, a reassuring voice/approach
Not medical records

4. Concerns and considerations

Throughout the sessions some concerns were raised over the service, in addition to the service limitations.

The right number of clinicians need to be available
Call handlers need to be well-trained in people skills

Growing too quickly

There was a big concern across both Reading and Aylesbury groups of the service being stretched and trying to do too much.

Paediatric Pathway

There were also considerable concerns raised around the order of questioning on NHS Pathways. This largely derived from patient’s existing professional or personal experience of NHS Pathways (rather than the demonstration).

The concerns were around the order of questioning and that for a paediatric pathways the question relating to difficulty in breathing came unrealistically late, following demographic information being shared.

Non-Clinicians answering calls

All groups questioned that non-clinicians should be answering the calls, in Oxford specifically there was some discontent over the access to Out of Hours being subsumed by the NHS111 service. This led to some boundaries to these specific individuals thinking through the idea of the NHS111 integrating further with other local services, as they had a disagreement with the fundamentals of NHS111.

Access to Records

Across all workshops there were questions raised over non-clinicians having access to records. Whilst all groups supported the idea of NHS111 having better access to their records to be able to provide more appropriate care, they unanimously felt that this should only be accessible to clinicians in the service (not call advisors

5. Evaluation Feedback

Evaluation forms were made available at the end of the Oxford and the Reading sessions.

Direct feedback was received from the 2 attendees in Aylesbury.

The Aylesbury attendees raised concerns over their ability to register for the event, which they had found challenging and thought that the link to the email address didn’t work. We also discussed the positioning of a Friday afternoon event not being very attractive to some people.

Overall the Aylesbury attendees were keep to express their views on NHS111 and understand in more depth about the service. It was a small interview and this lent the attendees to give positive feedback to the facilitator.

Summary of responses to the Evaluation Form (Oxford and Reading)

No / Question / Oxford / Reading
Yes / No / Yes / No
1 / What was the presentation like?
2 / Did you find it interactive? / 9 / 1 / 13
3 / Did you have the opportunity to get your views heard? / 8 / 2 / 12 / 1
4 / Did you find it informative? / 8 / 1 / 13
5 / Was it well facilitated? / 9 / 0 / 13
6 / How could it be improved?
7 / Do you want to carry on being involved / 9 / 0 / 11 / 2
Oxford / Reading
1 / What was the presentation like? /

Interesting and informative
Very useful and informative. The presenter communicated well and was responsive to questions. Allowed time and had to slightly adjust the presentation accordingly.
Useful
Informative
Interesting really needed more time. I hope other views will be taken notice of and we are not just a “We consulted” session
W/Shop have been OK if not interrupted so often, W/shop have liked to do the “pathways” in detail rather than rushed
Informative

Quite informative
Bit rushed
Excellent
It was very informative
Broadly informative. Seems good level for range of attendees
Good slides

2 / Did you find it interactive? /

Knowledgeable participation.
Not enough time
Too much

There was a lot of interaction with groups
I found the group talks very good
Well-presented nice slides, especially ----

3 / Did you have the opportunity to get your views heard? /

Well set out with small tables to enable discussion
Not enough time
Too many people making long speeches rather than being brief and to the point

There were many opportunities to ask questions
Not enough time for everyone to speak, some domination.
Yes plenty I just didn’t have much to ask.
Group work useful

4 / Did you find it informative? /

But less than hoped

I learnt a lot about 111
Fully explained 111 service
Very
It was nice to see that work on 111 is on going
Very, new information to last time (I’ve done a workshop four weeks ago – Same lady)

5 / Was it well facilitated? /

Relaxed yet well informed
Generally well facilitated timing ran over
Yes, but insufficient for my chairs and managers
Debbie managed the meeting well

It was well facilitated
Well informed facilitator, but maybe needed to elevate more comments from the quieter members

6 / How could it be improved? /

Possibly longer
No
Possibly more time
Sharing with the whole room the ‘what next’
More feedback re 999 calls now 111 in operation, retention of 111 staff, overall very interesting
Felt I wanted to know more
More time
Ensure that information is given priority, so that people focus on the point and participants get more information

It could be improved by hearing the opinions of others
I found group work good so maybe more of that
Better informed about future strategy.
An informative and interesting evening
The number of people present was about right perhaps
Slow and repetitive, this could have been much shorter. Less jargon. Have we added anything new or just confirmed the situation and progress to date so far?
some younger people could be included.
Maybe a daytime option same days? (i.e. this identical session to catch people, online questionnaire to focus group