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Islington CCG NHS 111 & GP Out-of-Hours Samit Shah Clinical Lead, North Central London NHS 111

Islington CCG NHS 111 & GP Out-of-Hours Samit Shah Clinical Lead, North Central London NHS 111

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Page 1: Islington CCG NHS 111 & GP Out-of-Hours Samit Shah Clinical Lead, North Central London NHS 111

Islington CCGNHS 111 & GP Out-of-Hours

Samit ShahClinical Lead, North Central London NHS 111

Page 2: Islington CCG NHS 111 & GP Out-of-Hours Samit Shah Clinical Lead, North Central London NHS 111

Introduction

Focus:

• Procurement of a combined NHS 111/Out of Hours (OOH) service,

with other North Central London CCGs, by April 2016

What we will cover:

Context – our urgent care review

Explain the clinical model for NHS 111 and out of hours services

Plans for re-procurement of NHS 111 and GP out of hours services

An update on the engagement we are undertaking

Next steps

Page 3: Islington CCG NHS 111 & GP Out-of-Hours Samit Shah Clinical Lead, North Central London NHS 111

Local Context

• 2010: GP OOH delivered to C&I by Harmoni

• 2012, November: Care UK take over from Harmoni

providing OOH Service

• 2013, April: LCW (not for profit) commence contract to

provide 111 for C&I

• 2013, October: Primary Care Foundation review of

Harmoni/Care UK Out of Hours Service. The review

found the service was clinically safe and provided good

care.

• 2014, March: Urgent Care Review Camden and Islington

Page 4: Islington CCG NHS 111 & GP Out-of-Hours Samit Shah Clinical Lead, North Central London NHS 111

Urgent Care Review: Community engagement

• Engagement August to November 2013

• Through media and advertising; online survey; audit day; workshops with community groups

People wanted:• Smooth and efficient links between NHS111 and OOH • A service that is easy to use and accessible • Staff operating NHS 111 have the right knowledge and skills• Easy referral into the necessary services • Everyone in the community will find the service easy to use• More local knowledge of NHS 111 and OOHs.

Page 5: Islington CCG NHS 111 & GP Out-of-Hours Samit Shah Clinical Lead, North Central London NHS 111

Urgent Care Review: Conclusions

Requires

High quality, safe care, 24/7, right care, right place, first time

Easy to navigate and understand with equity of access

A smooth patient pathway, with minimum number of organisations, repeated information gathering and handovers.

Recommends

Commission 111 across all of NCL

Combined NHS 111, GP Out of Hours (OOH) service as a single whole system model (though not necessarily a single provider)

Page 6: Islington CCG NHS 111 & GP Out-of-Hours Samit Shah Clinical Lead, North Central London NHS 111

The 111 patient journey in London

GP GP

ANSWER

APPROPRIATECARE

ASSESSMENT

London directory of local skills and services (DoS)Contains information for a wide range of organisations in a locality, includingopening hours, referral criteria, and real-time capacity

999 A&E UCC GP

in hoursGP

OOHNHS DirectMidwife

Mental Health crisis services

Pharmacy Rapid response nursing

Palliative care services, hospices

ACCESS

NHS PathwaysConsistent assessment of clinical needs

NHS 111 call advisersNHS 111 call advisersLocally commissioned call handling

Integration with pan-London ‘Co-ordinate my Care’ (CMC) Register for end-of-life care

Page 7: Islington CCG NHS 111 & GP Out-of-Hours Samit Shah Clinical Lead, North Central London NHS 111

111, OOH and LAS data Nov 13-Dec14

• Population of 218,000 (JSNA 2014)

• If every patient has four GP appointments per year, this amounts to approximately 880,000 appointments.

• Circa 25,000 calls to NHS 111:

• Circa 18,000 calls to GP out of hours services

• Circa 22,000 attendances at UCLH Emergency Department

• Circa 35,000 attendances at Whittington Emergency Department

Page 8: Islington CCG NHS 111 & GP Out-of-Hours Samit Shah Clinical Lead, North Central London NHS 111

Re-procurement features

• Procurement is legally required by NHS England, current contracts end March 2016

• All the 5 NCL Boroughs, and across London

re-procurement is being undertaken

• It requires community engagement, not consultation

• GP out of hours services providing telephone assessments, face to face visits, and home visits.

Page 9: Islington CCG NHS 111 & GP Out-of-Hours Samit Shah Clinical Lead, North Central London NHS 111

Re-procurement features re 111

• It is a national requirement for all CCGs

• We aim that it will be across five boroughs, as now• It will be an integrated service

– this does not necessarily mean a single provider for both services, partnership bids are encouraged

• NHS 111 is a nationally mandated model, but we will adapt as much as we can to fit local need.

Page 10: Islington CCG NHS 111 & GP Out-of-Hours Samit Shah Clinical Lead, North Central London NHS 111

What’s possible?

• One governance structure

• Improved pathways for patients (avoiding patients

repeating information)

• Prescriptions available far earlier when a person calls.

• Quicker access to specialist help for dental problems

• Clinicians “in the room” enabling 111 staff to pass calls

directly to a GP

• Integrated IT: improving information flow and patient

experience and safety

• Direct booking of “in hours” GP appointments

Page 11: Islington CCG NHS 111 & GP Out-of-Hours Samit Shah Clinical Lead, North Central London NHS 111

GP out of hours

• Regardless of the future provider, will continue to offer “traditional” service of telephone, face to face and home visits assessments.

• Islington CCG Board committed to ensuring high quality service

• Until now activity split 40%tel, 40% F2F, 20% Visits

• By 2016- more telephone consultations from 111 GPs, and possibly more F2F consultations from local GPs

(via the extended 8-8 GP working (seven days/week)

Page 12: Islington CCG NHS 111 & GP Out-of-Hours Samit Shah Clinical Lead, North Central London NHS 111

Engagement undertaken

• Public engagement January to March• Community meetings undertaken with a wide

range of groups • Survey Monkey questionnaire to all GP practice

patient groups • Focusing on - Clinical Model & Procurement

Process

Page 13: Islington CCG NHS 111 & GP Out-of-Hours Samit Shah Clinical Lead, North Central London NHS 111

Engagement planIslington Borough User Group (iBUG) – mental health service users

Drayton Park Women’s Crisis House

Age UK

Body & Soul (HIV)

Elfrida Society (Learning Disabilities)

Young Carers

Disability Action Islington

Joint meeting with Camden; open meeting, 23 February, 5.30pm – 7.30pm, St. Pancras Hospital

Last Years of Life Group/Voices for Change, Bingfield Medical Centre

Last Years of Life Group, Islington Carers Hub

North Locality Patient Forum, Resource Centre, 19 March, 2.00pm – 5.00pm

Central Locality Patient Forum, Venue tbc, 26 March, 5.30pm – 8.30pm

South Locality Patient Forum, St Luke’s Centre, 31 March, 5.30pm – 8.30pm

Community Members / Independent Patient Group

Survey Monkey questionnaire to GP practice patient groups

HealthWatch

All GP practices in pan-Islington forum

Page 14: Islington CCG NHS 111 & GP Out-of-Hours Samit Shah Clinical Lead, North Central London NHS 111

Emerging themes GP OOH

• Everyone wants a high quality service (Patients, CCG Board, GPs, patient community groups)

• Some people think this should be run and/or delivered by Local GPs

• Others have focused on the need for “high quality GPs”- who may or may not be local

• Service needs to be responsive to diverse language needs and vulnerable groups

• Service needs to minimise unnecessary referrals to A&E or 999

Page 15: Islington CCG NHS 111 & GP Out-of-Hours Samit Shah Clinical Lead, North Central London NHS 111

Emerging themes - PPG feedback

• Following on from the December 14 PPG in South

• Provided a set of FAQ for any patient

• Sent a survey to all Islington PPG groups

• Asked for the survey to go to all the practices “virtual patient groups”

• Asked all the CCG to undertake the same exercise

Page 16: Islington CCG NHS 111 & GP Out-of-Hours Samit Shah Clinical Lead, North Central London NHS 111

Emerging themes – re 111

• Combining NHS111 and GP OOH is a good idea

• NHS111 and GPOOH needs to be able to make good links with the local health system

• NHS111 needs to be better at helping people with mental health needs

• Service needs to be more responsive to diverse language needs and patients with a disability

• Prescriptions, next day GP appointments, record sharing(with consent) – all well received.

• NHS 111 needs more marketing

Page 17: Islington CCG NHS 111 & GP Out-of-Hours Samit Shah Clinical Lead, North Central London NHS 111

Next steps

• This phase of the engagement finishes end of March• Report on the outcome of the engagement• Finalise on-going public involvement in the procurement

process• End March commence tendering process • Finalise the service specification by the end of April

ready for the second stage of the procurement • New service starts 1 April 2016

Page 18: Islington CCG NHS 111 & GP Out-of-Hours Samit Shah Clinical Lead, North Central London NHS 111

Involvement in the procurement

Are you are interested in becoming involved in the procurement process?

If so, please give your name to:

Lizzie Stimson

[email protected]

Page 19: Islington CCG NHS 111 & GP Out-of-Hours Samit Shah Clinical Lead, North Central London NHS 111

Questions

Page 20: Islington CCG NHS 111 & GP Out-of-Hours Samit Shah Clinical Lead, North Central London NHS 111

Questions

• Have you used NHS 111 or GP OOH service in the last year?

• How would you rate your experience of NHS111 and OOH?• When you call 111, how important would it be to you to be

able to talk to the following healthcare professionals?• GP• Pharmacist• Nurse• Paramedic• Dentist• Mental health professional

• Is there anyone else you’d like to be able to talk to? Please specify

Page 21: Islington CCG NHS 111 & GP Out-of-Hours Samit Shah Clinical Lead, North Central London NHS 111

Questions

• Would you like the 111 or OOH service to be able to book an appointment at your GP practice the following day if it was thought necessary?

• We want our OOH GPs to have a good understanding of what local services are available in Islington when your GP is closed. How important is this issue to you?

• Is there anything else you would like us to consider?