In the 2010 Department of Health White Paper "Equity and excellence - Liberating the NHS", the government outlined its plans to introduce a country-wide, single three digit telephone number for patients to call with their urgent healthcare needs. This new number - 111 - will improve and simplify access to non-emergency healthcare for patients by providing access to a full range of services including referrals into community, primary and secondary care services. The service aims to both enable the best outcome for the patient as well as deliver an improved patient experience.
Harmoni's NHS 111 service complies with the national requirements laid down by the Department of Health and will incorporate NHS Pathways, a software decision support tool which enables clinical assessment at the patient's first point of contact with the service. The service is thus able to offer easy and accessible pathways to patients. It will provide consistent, high quality clinical assessment and call handling / administration services to support locally agreed care pathways.
The NHS 111 service is designed to integrate into local health economies to provide alternative pathways and avoid non elective admissions. It helps reduce demand on A&E departments, whilst providing the best available, high quality care to the patient. Our patients are directed to the most appropriate service based upon their individual needs and requirements.
Harmoni's NHS 111 service model has six key components: access, assessment, signposting and booking of appointments, treatment, self management and planning.
The NHS 111 service will be operational, 7 days a week, 365 days a year. Patients are able to contact the service via a single telephone number, 111. They can call NHS 111 free of charge from any landline, mobile, internet phone or phone box. Patients will be automatically routed to a local NHS 111 operation based on their location.
Unlike standard out of hours services where patients are phoned back by a GP or nurse after their initial call into the service, the NHS 111 service will provide clinical assessment of the patient at the first point of contact. All calls should be handled and completed by the person who initially answers the call, but it is estimated that approximately 20% will need further clinical assessment. This further clinical assessment is managed in house.
Call handlers will initially take down the patient's demographic details, and then move on to the clinical assessment using NHS Pathways and following a carefully defined format. All calls are recorded. If the patient has a life threatening condition, the call handler is able to despatch an emergency ambulance without the need to transfer the call to the local Ambulance Service.
The clinical assessment seeks to identify the precise clinical skills and/or facilities required by the patient, and the time frame in which they must be accessed. This ensures that the patient will be referred to definitive care on first contact with the service in the majority of cases.
Signposting and booking
Full details of locally available services will be maintained in the electronic Directory of Services. This is a web-based directory that stores details of all local services and a detailed breakdown of the specific clinical skills each service can provide. The system also enables those services to register their capacity at any particular time, which can be used to avoid sending patients to services with restricted capacity.
In some instances, based on the locality, referral protocols will be in place with health care service providers which allow the NHS 111 service to book appointments and transfer information without the need for the customer to be re-assessed or simply direct patients to the most appropriate service.
The NHS 111 will proactively refer patients into the most appropriate locally available service which could include:
• Rapid response and crisis teams within community settings
• District nurses, community matrons and midwives
• Intermediate care teams
• Social care
• End of life care services, including hospice services
• Voluntary agencies
• In reach teams within emergency departments
• Minor injury and illness services or walk in centres, dependent on locality models
• General practitioners
- Health visitors
• Children's services
• Out of hours services
Where the patient is identified as requiring advice to enable their symptoms to be managed at home, the call handler will pass the patient over to a nurse via a warm transfer.
Although the NHS 111 service itself provides no treatment, it is essential that the service works in an integrated fashion along all referral pathways to which we send patients. Ensuring sound end to end clinical governance across all integrated pathways is an essential component of our service.
The NHS 111 service will provide management information to commissioners regarding the demand, usage and performance of local services in order to enable the commissioning of more effective and productive services that are designed to meet patient needs.
Referrals by GPs and other healthcare professionals
Harmoni's NHS 111 service also incorporates referral pathways for GPs and other healthcare professionals who wish to refer a patient with urgent medical needs. The GP is able to refer the patient into the service by phone, fax or a secure NHS email account.