To receive an update on NHS 111. (20 mins)
Minutes:
Dr Milligan of Wokingham Clinical Commissioning Group provided the Committee with an update on NHS 111. Her CCG responsibilities included NHS 111 and she was a lead for Berkshire West for the recommissioning of the service.
During the discussion of this item the following points were made:
· Nationally the need to redesign Urgent and Emergency Care had been recognised. Pressures across health, social and community care were significant. A fundamental redesign was required of front door access (NHS 111, 999, Out of Hours (OOH), A&E, Community, Social Care).
· Dr Milligan outlined the vision for change:
o people with urgent but non-life threatening needs get responsive, effective and personalised services outside of hospital;
o people with more serious or life threatening emergency have treatment in centres with the very best expertise and facilities.
· Integrated 24 hour 7 day a week access, advice and treatment services were needed.
· The Berkshire West Vision for Urgent Care was outlined in the Berkshire West 5 Year Strategy.
· Dr Milligan took Members through the Berkshire West model of care.
· NHS 111 had started 3 years ago as a pilot and was now due to be reprocured. Berkshire West had joined up with Berkshire East, Oxfordshire and Buckinghamshire for the procurement process.
· Dr Milligan took Members through some of the common myths relating to NHS 111;
o Patients wait hours to be answered – 97% of calls were answered within 60 seconds.
o Callers have to wait hours for a clinical call back – 82% of calls were closed at the first stage and of those transferred only 1% waited more than 10 minutes for a call back.
o Public do not know when to call NHS 111 – statistics suggested that marketing had been successful for NHS 111 as an urgent care service.
o NHS 111 does not refer to primary care – nationally 67% of callers were referred to primary care or the out of hours service. 6.8% of call in Berkshire West were referred to the Emergency Department and 8% had an ambulance dispatched.
o NHS 111 refers people to A&E who would not have gone there otherwise – statistics suggested that this was not the case.
o NHS 111 is increasing the pressure on A&E – 79% of NHS Confederation members had said it was not a big cause of pressure on A&E.
· Some changes had been made such as increased clinician input.
· The current NHS 111 and Out of Hours landscape was complex with non-coterminous boundaries, non-aligned 111 and OOH contracts, non-aligned with ambulance and other services and non-aligned performance and incentives. NHS England had confirmed in early July that closer integration of NHS 111 and OOH would be required.
· Following a formal announcement at the National Conference in May, the direction of travel and procurement for NHS 111 and OOH services were paused until after September 2015. Revised commissioning standards and supporting procurement advice for integrated services were due in September.
· The OOH service would be aligned with the NHS 111 service and a specification for the OOH service considered. There would be a move towards a 24 hour 7 day integrated model.
· Councillor Miall asked about peak call times and was informed that the NHS 111 provider, South Central Ambulance Service, had considerable experience of modelling for peak times and staff numbers were planned accordingly. Nationally there had been a 40% increase in calls to NHS 111 between Christmas and New Year.
· In response to a Member question regarding staff ratios, the Committee was informed that the ratio was four call handlers to one clinician (nurse or paramedic). There were also floor walkers who could offer support to less experienced call handlers if required.
· Councillor Miall referred to a recent undercover investigation of the 111 service by a Daily Telegraph journalist. Members were assured that an internal investigation was being carried out.
· Members questioned what difference NHS 111 had made. Dr Milligan commented that GPs were seeing fewer urgent cases and those who could be dealt with via other means such as pharmacy.
RESOLVED: That Dr Milligan be thanked for her presentation.