Topic: Improving NHS out-of-hours provision - what do you think?
Improving NHS out-of-hours provision - what do you think?
16 Apr 2015 18:02
PGC Webmaster Topic Author
Clinical Commissioning Groups (CCGs) in four North London boroughs are...
Clinical Commissioning Groups (CCGs) in four North London boroughs are looking to improve the NHS 111 service and integrate it with GP out-of-hours provision. Residents are invited to attend public engagement events, as described below:
NHS 111 and GP out of hours services engagement events
NHS Clinical Commissioning Groups in north central London (Barnet, Camden, Enfield, Haringey and Islington) have a vision to ensure the voices of patients and carers are at the heart of our decision making.
We are working to improve the local NHS 111 service. This includes joining up the NHS 111 service and the GP out-of-hours services to enable them to work better. We are doing it because we want to improve patients' experience of using and accessing urgent care services, making sure they receive the best care, from the best person, in the right place, at the right time.
We will be holding public engagement events across north central London as an opportunity to hear from you. All residents are invited to come along and share your views and experiences of existing services so that we can work together towards developing the best possible service.
Improving NHS out-of-hours provision - meeting on 19th May + details of proposed changes
18 May 2015 01:14
PGC Webmaster Topic Author
There will be another public meeting on this subject on Tuesday 19th May from 10am to Noon at the Beaumont Home in Cannon Hill, N14 7DJ.
Despite talk of "involving" residents, it appears that the North Central London CCGs have decided what they want to do and are simply presenting it to the public. What they are planning to do is to merge the 111 Service with the Doctors Out of Hours service. This would be a single contract (no doubt with a private sector company) to provide the integrated service throughout Barnet, Camden, Enfield, Haringey and Islington.
See the slides to be used at the meeting
Read the frequently asked questions (also reproduced below)
Frequently asked questions: NHS 111 / Out of hours GP services
In this document you will find a number of questions and answers about what’s happening with the NHS 111 and out of hours GP services in north central London.
Please add more questions!
If you have further questions you would like us to answer, please let us know. We can also send you a hard copy of this document if you need one. Our contact details are: 020 3688 2729 or email:
Summary – what’s happening
Haringey CCG is working with other CCGs in North Central London (Barnet, Camden, Enfield and Islington) to improve our local NHS 111 service. This includes integrating the NHS 111 service and the GP out of hours service to enable both services to work better together.
We are doing it because we want to improve patients’ experience of using and accessing urgent care services, making sure they receive the best care, from the best person, in the right place, at the right time.
The contract for the current NHS 111 service needs to be renewed in April 2016, which means we now have a real opportunity to learn from experience and make NHS 111 work better for patients.
1. What is NHS 111?
NHS 111 is a free telephone number to help people with urgent, but not lifethreatening conditions, get advice and access the most appropriate service to meet their needs. NHS 111 was introduced across the country in 2013. It is available 24 hours a day, 7days a week.
In North Central London (Barnet, Camden, Enfield, Haringey and Islington), the NHS 111 service is provided by London Central & West Unscheduled Care Collaborative (LCW - www.lcwucc.com ).
The NHS 111 health advisors ask callers for their details and some information about their symptoms. The health advisors will assess a caller’s symptoms using a clinical tool called ‘NHS Pathways’. At the end of the assessment the caller will be directed to the service that is most appropriate for their symptoms or, if appropriate, will be given self-management advice.
For callers whose symptoms indicate the need for a referral to a GP outside of their normal GP surgery opening hours, their call will result in a referral to their local out of hours GP service.
2. What does GP out of hours mean?
GP out of hours services are available so that people can still access primary care, for urgent problems, when their GP surgery is closed at night or over the wee kend. In Camden and Islington, GP out of hours services are provided by Care UK. In Barnet, Enfield and Haringey, the GP out of hours service is provided by Barndoc.
3. How do patients currently access GP out-of-hours services?
GP out of hours services are accessed via the NHS 111 service. There is a GP out of ours base in each of the five boroughs where people can be seen. If a patient is not well enough to attend an appointment, or the centres have closed for the night, Barndoc/Care UK will provide a home visit if clinically necessary.
4. Why do we want to change NHS 111 and GP out of hours services?
There is duplication and inefficiency between the two services. For example: Patients needing help from the GP out of hours service are usually assessed at least twice: once by NHS 111 and once by the GP out of hours service. This process makes it harder for patients to access the help they need quickly.
It is clear from our modelling that North Central London is the right scale at which to commission these services. When we compare the locations of 111 callers with their borough of GP registration, North Central London patients tend to move between North Central London boroughs and primarily access services within North Central London. We think we can improve access, quality and choice by commissioning these services together on behalf of our local populations.
5. What we are planning to do?
We want to integrate the GP out of hours service with NHS 111 across North Central London (NCL). This does not necessarily mean that a single provider will provide all parts of the integrated service. For example, there could be a lead provider who is awarded the contract and they may sub-contract the out of hours GP service to another organisation or organisations, or vice versa; or a group of providers may seek to work in partnership and offer an integrated service. This could mean that a lead or single provider would be responsible for the qua lity of the overall service and the contract management, which will help support quality improvement across the patient pathway.
This change has been a recommendation from multiple reviews of unscheduled care, at both local and national level, including:- NHS England’s Urgent and Emergency (Keogh) Review Camden & Islington Urgent Care Review (2013)
Camden Health Scrutiny Panel Report (2013)
Primary Care Foundation review of out of hours provision in Camden and
Combining the two services will ensure a more seamless experience for patients with fewer handovers and more efficient triage. Patients should only have to give their information once – at present, if referred to the out of hours service, they have to give information twice. Common processes, procedures and IT infrastructure will make it a better service.
6. Why will this make things better?
The biggest difference will be the integration of the clinical workforce and the supporting IT systems for NHS 111 and the out of hours GP service. This means that patients will be referred to a clinician who will have access to clinical information that will support their ability to provide advice; and will also avoid patients having to repeat their symptoms at multiple stages.
We also want the NHS 111 service to be able to make appointments with the GP out of hours service on that initial phone call – something which is not currently possible. This should result in a much better and quicker experience for patients.
7. What will this mean for patients?
We hope that patients will experience an improved service with easier access to their out of hours GP service and to other local services. Patients will continue to access the GP out of hours service by calling 111. NHS 111 and GP out of hours will share the same IT and clinical systems, which means that patients will not have to repeat their details and symptoms twice.
8. Why has there not been any public consultation on these proposals?
The changes being planned are part of the procurement of GP out of hours services and NHS 111 are chiefly changes in how the providers are organised, rather than significant changes in how the services are actually delivered. Patients will not experience any difference at all in the level of service they receive – though we hope in time that the changes will enable improvements in patients’ experience of the out of hours and NHS 111 service.
A public engagement programme has started and will continue at both borough and North Central London level. Each CCG will be engaging with existing patient groups and forums as well as collectively at bigger events across North Central London. Patient representatives will be involved throughout the procurement process and all the North Central London CCGs will be discussing the plans with local patient groups. We have also discussed the plans with local GPs and providers. 17.02.2015 As far as we are aware commissioners elsewhere are not consulting on their procurement plans for out of hours and NHS 111 services.
Department of Health guidance states that there is no requirement to involve users where proposals for change or a decision to be made for an NHS organisation, for example a change of provider, does not result in changes to the service that affect the way in which that service is delivered or the range of services available. The procurement will not affect: access, location or the range of services offered. It is aimed at enhancing these, and also improving quality in terms of integrating services and delivering a better patient experience.
9. What do we want from NHS 111?
We want NHS 111 to:
Be a single point of access for urgent care, available online or over the phone 24/7
Give patients direct access to clinical advice from a nurse, paramedic, pharmacist or GP
Be fully integrated with local healthcare services enabling:
Direct appointment bookings into other services, including home visits
Timely transfer of relevant information about each patient to those involved in the patient’s care
Better access to patients’ medical histories
The immediate dispatch of an ambulance, if needed.
Easy access to the out of hours GP service, if needed
10. When will the new service start?
We would like the new integrated service to start in April 2016. This will ensure that there is enough time for a full and proper procurement process. Local clinicians are very involved in developing the service specification for this procurement. We know that we need to make sure we communicate what is happening with people in all five boroughs and all CCGs are developing local engagement plans.
11. Will patients and members of the public be involved in decision making?
The commissioning of NHS 111 and GP out of hours does not include any plans to substantially alter access to services. The CCGs have already started a process of involving stakeholders and members of the public and will continue to do so. Members of the public will be involved in a number of ways:
Patient and Healthwatch representatives on the programme board 17.02.2015
Representatives involved in the procurement process
Public and patient events
Involvement of local GPs on behalf of their registered population
Feedback received through local authorities and other service providers