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NHS 111 specification

Contents

NHS 111 Specification – introduction 2

Vision/aims of NHS 111 3

NHS 111: The basics 3

Who is NHS 111 for? 3

What patients can expect the new service to do: 3

Basic service outline 4

Introducing CATS 5

How it will work in practice: 5

Further Information 9

Telephony and Digital Service 9

Clinical Assessment and Treatment Service 17

Priority areas for developing integrated care 19

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NHS 111 Specification

Walk-in centres, urgent GP appointments, minor injuries units, hubs, rapid response

services…….

We know this range of services is confusing. It’s a problem nationally. We are determined to make it easier to use. A recent review of urgent and emergency care by NHS Medical Director Sir Bruce Keogh set

out the five key elements or areas for change that need to take place to improve care:

To provide better support for self-care.

To help people with urgent care needs get the right advice in the right place, first time.

To provide highly responsive urgent care services outside of hospital, so people no longer choose to queue in A&E.

To ensure that those people with serious or life-threatening emergency care needs receive treatment in centres with the right facilities and expertise, to maximise chances of survival and a good recovery.

To connect all urgent and emergency care services together, so the overall system becomes more than just the sum of its parts.

NHS 111 is an important part of making this happen – you’ll see how these key areas are reflected in the outcomes and the basic outline of the new service below. If you need urgent or unscheduled care, NHS 111 will become the first point of contact for

you.

Unlike the current NHS 111, the new service won’t only provide advice or signpost you to

other services.

It will also be able to help more directly, including:

book appointments for you directly,

arrange a home visit where needed,

help you get a repeat prescription

transfer you directly to a local GP who can help with advice over the phone.

A quick word about jargon We know the NHS is too fond of jargon. This document is based on a technical specification so, while we’ve tried to cut it out where possible, it will occasionally be hard to avoid. You’ll also see these boxes throughout that will help explain some of the terms we use. Here’s your starter for 10:

What is unscheduled care? This is any unplanned contact you have with the NHS. This can range from a visit to A&E to an urgent GP appointment. By its nature, demand for unplanned care can happen at any

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time, and services must be available to meet this demand 24 hours a day. Unscheduled care includes urgent care and emergency care.

Vision/aims of NHS 111

Make unscheduled care services easier to use and better for patients.

Get patients to the right care more quickly – reducing unnecessary steps

Make using the NHS for unscheduled care less complex and confusing.

Support NHS 111 with IT that helps the sharing of patient records, referrals and

booking of appointments as part of an integrated system.

Unscheduled care is coordinated between Primary, Planned, Urgent, Intermediate,

Mental Health, Social Care, Community and Paediatric care services and other parts

of the healthcare system.

NHS 111: The basics

Who is NHS 111 for?

Obviously this could be any of us but specifically it is a single entry point for patients who:

may need medical help fast, but it’s not a 999 emergency don’t know who to contact for medical help think they you need to go to A&E or another NHS urgent care service

require health information or reassurance about what to do next.

What patients can expect the new service to do:

Outcomes

1) Right care, right place from people with the right skills

Improve access to unplanned care so the right care is in place for your needs.

2) Enhance quality of life for people with long-term conditions

People with long-term conditions are treated in-line with their care records and wishes and

get the most appropriate treatment for their needs first time.

3) Help people to recover from episodes of ill-health or following an injury

NHS 111 responds to your immediate need in a timely fashion and arranges for any follow-

up care and support required in one go.

4) Ensure people have a positive experience of care

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NHS 111 will make using the urgent and emergency system easier for patients

Patients get information and options for self-care and are supported to manage an acute or

long-term physical or mental condition.

NHS 111 will ensure the early input of the most appropriate senior clinician when required.

5) Treat and care for people in a safe environment and protect them from avoidable harm

NHS 111 will provide the same quality of care to all patients using the service.

Your needs are met within a single episode of care – fewer handovers and less telling your

story over and over.

Other required outcomes

Less duplication leading to a more efficient and productive urgent care system.

Better access 24/7 to urgent care

Patient and/or their family/carers get information and options for self-care so they can

safely manage acute or long-term physical and mental conditions

Seamlessly onward referral (where needed) e.g. through direct booking of

appointments at a wider range of urgent or unscheduled care services.

Increased public satisfaction and confidence in the NHS, and particularly 111

Continuous improvement based on measuring quality and experience of patient care.

Basic service outline

The new NHS 111 will

Be open 24/7 all year

Be accessible, personalised and based on your individual needs

Have knowledge of when you have previously contacted NHS 111 so you do not need to repeat their story

Be able to connect you to a clinician with access to important health records and notes

Be safe and give the right advice based on the best and most up to date clinical and medical knowledge available

Definitively resolve health concerns without the need to go anywhere else – if appropriate

Be able to book appointments with the urgent care provider you need

Be able to dispatch an ambulance without delay if necessary

Be accessible through digital or online channels – both to give better access to information and to meet specific needs people have

Make sure that specific health needs, such as palliative care, mental health and long term conditions are properly catered for.

NHS 111 should provide a consistently high quality service irrespective of the geographic area.

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Introducing CATS

One of the key concerns about NHS 111 with the public and some staff groups has been

that call handlers are not clinically trained.

In the new service, NHS 111 call handlers will be supported by whole teams of clinicians –

local GPs, nurses, pharmacists and other clinicians – who you can be referred to for help.

This includes seeing you in person or organising a home visit.

This support is called CATS – Clinical Assessment and Triage Service. The core

components of the CATS will include:

A core GP and nurse-led service who will assess, provide advice, provide telephone treatment or book onwards treatment for patients calling NHS 111 on an Out of Hours basis;

The CATS will also link into a network of urgent and emergency care services. As set out in this document, CATS will be able to book appointments into these services for you. Over time, CATS will integrate with these services more and more – both in terms of the range of services you can be booked into and the IT systems that will support this.

Who will staff it?

Specialist or advanced paramedics with primary care and telephone triage competences;

Nurses with primary, community, paediatric training and/or urgent care experience;

Prescribing pharmacists; and

GPs with enhanced telephone assessment skills. Wherever possible individuals working in the clinical hub will be based in that community, and must be able to liaise with local physical and mental health services and social care.

How it will work in practice:

The diagram below sets out how it works. You may also hear the following bits of jargon in

relation to this so we’ve provided an explanation.

What is algorithm? An algorithm is a set of rules or a process that needs to be followed in order to solve a problem. For NHS 111 the process is a series of questions to go through in order to identify what’s wrong and then direct you to the right care.

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What is a pathway? This is simply the sequence of care the NHS will offer you for a particular health complaint. For many people – particularly those with the most complex care needs – you might need help from several different clinicians or services to help you get better. We map out the movement between these services in a pathway.

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You call NHS 111

Non-clinical call handler assesses you

System shows you don’t need CATS

Call ends with advice – e.g. visit to pharmacy

System findss existing care plan or specific needs based on access to shared records

Care from relevant team or service provided

Assessment shows you need support from CATS

Patient speaks to appropriate clinician – GP, nurse, pharmacist etc.

Patient given clinical advice or booked directly into a service e.g:

GP appointment UCC appointment Dentist

appointment Community service Pharmacy Home visit

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Questions about specific services

What if I need a dentist?

Dental pain without injury remains one of the highest reasons for calling NHS 111. During normal hours (Monday to Friday 08:00 to 18:00), NHS 111 will refer you to the most appropriate service that’s open.

At night, (0800 in the evening until 0800 the following morning), the new provider of NHS 111 will handle your complaint and direct you through to the Dental Assessment Service. This will include a report that can be added to your medical records.

All call handling staff will be trained to spot and help manage dental trauma.

How will you help people with mental health issues – especially if there’s a crisis?

Clinicians will have access to relevant aspects of a patients’ mental health crisis record. Included in the record will be your networks of support and the recovery outcomes you’ve defined.

They’ll also be reviewed regularly and kept up to date –particularly following any crisis or significant change in your circumstances.

The service will also have information on the factors that have the potential to lead to a crisis and what steps can be taken to help.

In accordance with the Mental Health Crisis Care Concordant, NHS 111 will work with local mental health services to identify people who need mental health support early and forward them on to the right place quickly. NHS 111 work in partnership with mental health services to;

Access crisis plans (so you’ll get the help you need if you phone 111) Agree referral protocols for mental health patients in crisis; and Complete patient pathway reviews to ensure support continues to improve.

Pharmacists – can I re-order prescriptions urgently?

Pharmacists will be available in the clinical hub or CATS.

Advice from the pharmacist will include:

Medicines enquiries; Health information enquiries; Requests for urgent repeat medication; Medicines advice for minor illness; Poisons and accidental overdoses; Contraception advice; and Any other advice that a registered pharmacist with training is able to provide.

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Further Information More information about the service follows below. The service is split into two main components: Telephony and digital service – the nuts and bolts of the systems that will make NHS 111 work along with information on how certain calls will be handled, updating clinical records, staff training etc. Clinical Assessment and Triage (CATS)– how CATS will work – opening hours, how it will work with the NHS 111 call centre and how we want it to integrate with other services and programmes of work we are doing in NW London.

Telephony and Digital Service

How you will get through to NHS 111

Any agreed channels – but specifically telephone and digital channels. The service will accept any call from Heath Care Professionals (HCP) calling for

clinical advice. This includes the following organisations: o Ambulance Services o Urgent and Emergency Care Services o Community Services o Social Care professionals o Primary Care o Other 111 services o Community specialist services o Learning Disabilities services

Key features of the IT and telephony

There are a range of key features of the IT and telephony supporting the new NHS 111

service. These include

submit and retrieve data from the National Repeat Caller Service; Update patient records where agreed and where you’ve given consent Book direct appointments and referrals To text message patients with a summary of the call including any self-care advice or

onward referral/booking arrangements. Provide real time performance and detailed symptom and outcome data Dispatch an ambulance automatically where clinically indicated without delay Integrate with Choose and Book (e-referrals) for the purposes of booking into

services (where booking occurs);

National Repeat Caller Service Where a patient (or their carer) calls the NHS 111 service three times in 96 hours, the third call should only be assessed to see whether or not an ambulance is required. If an ambulance isn’t needed, then the call must result in a ‘Speak to GP within 1 hour’ disposition

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The GP must be alerted to the fact that this is the third time in 96 hours that the caller has made contact with the NHS 111 service and they should therefore complete a thorough re-assessment of the patient’s needs. The GP should be sent details of all three calls. An exception is made for the small minority of people who regularly make frequent calls to the same service and where there is an agreed care plan for the particular patient (e.g. palliative care, long term conditions etc.)

Clinical records

The aim across NWL is to ensure that where you have a care plan in place, you are treated

in accordance with that plan. To support this aim all clinicians within the urgent care system

linked up with CATS should have access to relevant aspects of your care records, where

you have given consent to this being available.

IT systems will link up with both Systole and Emmis – the two programmes used by GPs in

NW London to record consultations with patients.

Special notes and Health Advice note

One of the issues with NHS 111 – especially for clinicians – has been that the system has

been unable to view special patient notes. These notes are compiled by your family doctor

and often contain important information about how best to look after you.

These are especially important if you have complex needs or a long term condition.

The new NHS 111 service will support the development of a single Health Advice note which

will function as a special note and support the health advisor refer the patient to the correct

place.

Direct booking of appointments

The Provider will be required to have direct booking capabilities in place for all agreed Out of

Hours bases and Urgent Care centres for service commencement, with system capability to

direct book into

Primary Care and extended services Out of hospital/Community based services across each CCG where functionality

exist including the ability to refer and book into the current three main systems in use across the CCGs, clearly presenting to the patient, the options available to refer and book appointments

o Emis o System 1 o Adastra (Advanced Health Care)

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Staff training

All staff involved in handling Integrated Urgent Care calls will undertake training that covers

the following areas as mandatory:

Learning from the outcome of the review of complex and primacy calls Compliance with the licence requirements of the relevant Clinical Decision Support

Software (CDSS) (Clinical assessment system and clinical assessment training); Safeguarding - An overarching requirement is that all staff must be trained in

recognising and dealing with vulnerable adults and children, Providers will have in place approved policies which meet with statutory requirements;

How to interact with urgent care services; The role of Directory of Services; NHS values - General NHS 111 principles, culture and values; Delivering excellent customer service; Use of core clinical systems including SCR, SPN, EPaCCs and shared care records; Consent to access and share patient records; and, Local formalisation and partnership working training.

Staff will also receive mandatory training in an agreed range of areas including health and

safety, risk management and fire safety as agreed with the North West London CCGs.

Additionally staff will be required to undertake training in a variety of specialized areas,

including but not limited to:

Mental Health,

Learning Disabilities,

Dementia

Training doctors and other healthcare professionals

The provider will work with Health Education England to become an approved training location for doctors and other healthcare professionals. This will include providing training opportunities for GP Registrars, subject to agreement with Health Education England. Medicine and poisons training NHS 111 is now the primary user of the National Poisons Information Service (NPIS) to

support the handling of accidental poisoning and overdose calls in urgent care. Toxbase is

the recognised web based resource to support clinicians handling toxic ingestion calls and

supporting decisions about self-care.

Front end messages

Using voice recognition technology you should be able to access other services such as a

pharmacist (for a repeat prescription) or dentist (when it’s clear that’s all you need) without

going through to a call handler.

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Calls in other languages

The service will have access to a translation service 24/7/365 to translate calls made in other

languages.

Health Advisors need to know how to organize a translator without delay and ensure a

translator is available within 15 minutes.

Calls from people with hearing impairments

The service will deliver a good quality service to patients with hearing impairments.

Health Advisors will be trained to understand how to handle calls from people with hearing

impairment.

These calls should be tagged following the patient’s first call if this is consented to so that

the service can review these calls and improve the response for these patients in the future.

Accessible Information Standard

All NHS organisations will have this standard. It requires them to:

1. Ask – if there are any information and communication needs

2. Record – needs in a standardised way

3. Notify/flag – on a person's file

4. Share info – about people across organisations

5. Meeting needs – people receive information they can understand and receive communication support.

You can find more information about the standard here – http://www.brentaccessibleinformation.nhs.uk/

Other help for specific groups

We’re trying to make the system as effective as possible at getting people to the right care at

the right time.

We know certain patient groups would usually be treated most effectively in certain ways.

For example, parents of small children phoning out of hours are understandably always

concerned about their child. The new system will make sure you are offered a face-to-face or

phone consultation – once a life-threatening issue has been ruled out.

Jargon alert – the following sections are quite technical. You’ll need some of the definitions below

http://www.brentaccessibleinformation.nhs.uk/

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When am I symptomatic? When someone has the common symptoms associated with a disease or condition, they are considered symptomatic. What is a disposition? A disposition is a first assessment of what care you need based on the information you provide to the NHS 111 service. Typically dispositions range from advice on self-care to calling an ambulance. It’s important not to confuse this word with diagnosis which is the clinical identification of what is wrong with you. What is a warm transfer? This is where your call is transferred to a clinician directly, while you are still making your original call over the phone. Transferring this call is quicker and does not mean you have to repeat your story. What is a DoS? Directory of Services. Like a phone book, it lists all the services that NHS 111 can put you in touch with. What is NHS Pathways? Pathways or NHS Pathways is a common computer system used by NHS 111 and ambulance services. What is OOH? This stands for out of hours – usually defined here as weekends and 18.00-8.00 Monday to Friday. What is a single point of access? Like the name suggests it is typically a phone number you can dial for a specific service and is often open 24/7. For example, there are two mental health single points of access covering different parts of NW London.

Patient Groups

New Pathway during OOH period Pathway during in-hours period

Under 16s,5s,2s,1s

Under 2s Once a clearly life-threatening issue has been ruled out, Health Advisors offers phone consultation or face to face appointment Under 16s

Under 5s Once a clearly life-threatening issue has been ruled out Health Advisor offers phone consultation or face to face appointment Follow normal pathway route.

https://www.healthiernorthwestlondon.nhs.uk/bettercare/mentalhealth

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Health Advisors follow pathways offer the option of a face to face or phone consultation if required from the CATS clinicians

CMC/ End of Life Patients

Telephony System recognises telephone number and looks for a palliative care specialist or clinician in the hub.

Where clinician is not directly available, the Health Advisor takes details and transfers you through to local palliative care team or into the hub clinical queue for highest priority call back.

Where life-threatening, the Health Advisor will immediately ask for clinical review of notes to identify appropriateness of disposition and management plan before dispatching an ambulance within 30 seconds.

Telephony System recognises you have an end of life plan

The Health Advisor transfers you through to the local palliative care team or into the hub clinical queue for priority call back. Where life-threatening, the Health Advisor will immediately ask for clinical review of notes to identify appropriateness of disposition and management plan before dispatching an ambulance within 30 seconds.

Patients with Management / Crisis Plans

Health Advisors rule out life-threatening and warm transfer you to clinical hub.

Health Advisor rules out life-threatening and transfers to pathways clinician to use notes and manage appropriate onward referral

Nursing and Residential Homes

Triage via health advisor and, where required, clinician, utilising the DoS for onward referral

Complex Patients

Health Advisor identifies call as a complex case and early exits with a direct transfer to the urgent care hub

Health Advisor identifies call as a complex case and early exits with a direct transfer to clinician

Mental Health Patients

For non-medical issues – if you are new to mental health services or use them already – that lead to a mental health disposition you’ll be transferred from 111 to the mental health SPA for the area.

For non-medical issues – if you are new to mental health services or use them already – that lead to a mental health disposition you’ll be transferred from 111 to the mental health SPA for the area.

Frequent Callers

Frequent callers to be reviewed as a minimum monthly and patient notes will be developed on appropriate patient management pathway including direct discussions with GP practice that may include direct referral to a clinician, clinical hub or urgent referral to own GP practice. If you call three times in 96 hours you’ll be directly transferred to the clinical hub. If the outcome is not to send an ambulance to ED, then the call must result in a ‘Speak to GP within 1 hour’ disposition and the GP must be alerted to the fact that this is the third time in 96 hours that the caller has made contact with the service and they should therefore complete a thorough re-assessment.

Frequent callers to be reviewed as a minimum monthly and patient notes will be developed on appropriate patient management pathway including direct discussions with GP practice that may include direct referral to a clinician, clinical hub or urgent referral to own GP practice. If you call 3 times in 96 hours, you’ll be directly advised to contact your GP surgery and the GP should be sent details of all three calls.

Health Care Advice

Provided by Health Advisor or Pathways Nurse

Non-urgent dispositions (speak to a clinician in 2

A clinician will be made available

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hours)

Over 75s Direct transfer to clinical hub Direct transfer to NHS 111 clinician

Dental Calls

You’ll be managed by the NHS 11 service and the DoS help find the most appropriate local service

The service will identify if you’re calling for dental and use Pan-London agreed dental questions and transfer the patient to the Pan-London dental service.

Repeat Prescriptions

Referral to local service Early exit and referral to urgent repeat medicine service

Medication enquires

Early exit for call back from clinician Early exit and referral to urgent repeat medicine service

Out of London calls

Pathways triage via health advisor and, where required, clinician, using the DoS for onward referral

Patients from within London

Pathways triage via health advisor and where required clinician, following the DoS for onward referral. Systems must have the capability to transfer patients to other NHS111 providers and local clinical hubs.

Reviews

Review systems will be a core quality requirement of the service.

Critical reviews should form an integral part of all aspects of the services’ operations and

delivery.

The Provider will have to demonstrate how learning from call reviews, audits, serious

incident reports, complaints commendations and feedback is incorporated into service

delivery and development.

Workforce

The NWL NHS 111 component will use nationally-approved software such as NHS

Pathways to assess and triage symptoms.

Health Advisers and clinicians will be trained properly to use the system to assess the needs

of callers.

The software will support handlers to spot calls that need transferring to a clinician in NHS

111 or CATS. It will include as a minimum: (this is covered in pathways table above)

Clearly identifying where a Patient is aged 5 years and under; Clearly identifying where a Patient is aged 79 years and over; Calls that need an ambulance Follow up home management/self-care advice – text or phone call depending on the

best way for you Recognising complex cases – multiple co-morbidities, no clear symptoms;

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Multiple symptoms Patients with clinical care plans / special patient notes; Patients registered with end of life services; Repeat and frequent callers; Patients that have asked to speak with a clinician; Healthcare professionals that require clinical advice; Patients that have been assessed and identified as requiring clinical advice; and Refused dispositions

Working with 999

If the call is symptomatic (i.e. about an illness or injury) the first step of the assessment is to

establish that the patient is breathing, conscious and not bleeding heavily, or not

experiencing a life threatening condition.

All emergency ambulance treatment and transport dispositions (green dispositions) and

Emergency Department dispositions generated by Health Advisors will be referred to a

pathways clinician before the ambulance is dispatched or the patient is sent to ED.

Unresolved calls

Sometimes a call can not be resolved by the health advisor. In these cases, the call must be

warm transferred from the Health Advisor to the most appropriate clinician.

Caller needing self-care

If you need help to manage an illness at home you will be referred to a clinician via a warm

transfer.

I just need some advice (non-symptomatic)

This will be provided by the call advisor.

What happens afterwards?

At the end of every call, you will get specific evidence-based advice on what to do if your

symptoms worsen, and guidance on particular issues to look out for which may indicate the

development of a more serious condition.

All calls must end with advice to call back if anything changes.

You may also be signposted, as appropriate, to local services in your locality, e.g. diabetes

support groups, asthma society which could help to support and encourage further self-care

and self-management.

Where possible the face-to-face consultation assessment information will be sent to the

selected service electronically.

Where you are expected to attend or contact the service you are being referred to yourself,

the NHS 111 service will provide the relevant contact details directly to you.

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Where it is possible the NHS 111 service will book you directly into a service.

Clinical Assessment and Treatment Service

The Clinical Assessment and Treatment Services (CATS) will be made up of experienced

generalist and specialist clinicians working together with NHS 111 to provide urgent care

assessment and treatment to patients. In particular, the CATS will help you when you:

need to 'speak to' or 'contact' primary care Out of Hours. have more complex conditions or need your health to be managed in line with an

agreed care plan; may benefit from the support of specialist clinicians. are at risk of an emergency hospital admission but may be suitable for urgent

reactive care in the home or community.

The CATS will consist of:

An enhanced “core” out of hours assessment and treatment service managed by experienced generalist clinicians with additional specialist clinical support as required.

The CATS will also link into a network of urgent and emergency care services. As set out in this document, CATS will be able to book appointments into these services for you. Over time, CATS will integrate with these services more and more – both in terms of the range of services you can be booked into and the IT systems that will support this.

How long will it be open?

The CATS will provide an enhanced core telephone triage service out of hours (18.30 hours

until 08.00 hours on weekdays and the whole of weekends, bank and public holidays)

The CATS will also bring together a range of telephone assessment and triage services from

across the CCG areas which operate 24/7 – for example a single point of access for mental

health.

How will I speak to or use CATS?

A NHS 111 call handler will refer you

Direct referral from an online or smartphone app (this will be under development by the time the new service starts).

CATS will also take calls directly from local health professionals who require advice from a generalist or specialist clinician including community services, paramedics and social care professionals.

Moving my call from NHS 111 to CATS

In most cases, you’ll call NHS 111 and the call will be 'warm transferred' from a health

advisor or clinician within NHS 111, where this is appropriate.

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If you need out of hours help from a GP or primary care service you will be 'warm

transferred' from the health advisor or clinician within NHS 111 to a senior clinician within the

CATS, ideally this should be an experienced local GP or Advanced Nurse Practitioner.

If a 'warm transfer' is not possible, a senior clinician should contact you or your carer by

telephone, within a required timeframe.

Telephone assessment by CATS – key standards

These are the key standards for call handling

Start definitive clinical assessment for urgent calls within 20 minutes of the call being answered by a person.

Start definitive clinical assessment for all other calls within 60 minutes of the call being answered by a person.

Providers that do not have such a system must start definitive clinical assessment for all calls within 20 minutes of the call being answered by a person

Home Visits

If needed, a face-to-face home visit consultation will be booked in at your home. The

timescales (after definitive clinical assessment has been completed) are as follows:

Emergency: within 1 hour;

Urgent: within 2 hours; and

Less urgent: within 4 hours.

The clinician will either treat in-situ or, where required, send the patient to an appropriate

service for on-going treatment.

Face-to-face consultation

Depending on where you live you may be offered a face-to-face consultation at an out of

hours location. This will not be required for all CCG areas, with Urgent Care Centres and

other clinical settings within the local urgent care system being used for face to face visits as

required.

Emergency: within 1 hour;

Urgent: within 2 hours; and

Less urgent: within 6 hours.

These face-to-face consultations will normally be offered at the nearest or most convenient

centre to you. You will be informed of likely timescales and the service will contact you if an

agreed appointment time is delayed, utilising the latest technology (e.g. text messages),

where possible.

All treatments provided will be administered by suitably qualified clinicians with local

knowledge of systems and processes. A GP shall be available out of hours.

Walk-ins

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Where a face-to-face base is provided and patients walk in directly to a centre, it will be run

according to the following standards:

Start definitive clinical assessment for patients with urgent needs within 20 minutes of the patient arriving in the centre

Start definitive clinical assessment for all other patients within 60 minutes of the patient arriving in the centre.

Providers that do not have such a system must start definitive clinical assessment for all patients within 20 minutes of the patients arriving in the centre.

Supporting integrated care

The ultimate vision is to develop a contact point for all home and community-based care

services that you can use on a 24/7 basis.

This will need to be achieved through a variety of ways including:

Standardising, or improving the operability of, telephony and IT systems

Improving the sharing of information – where permission is obtained from you to share records in the first place.

Reducing the need to re-assess / re-triage patients across the services incorporated into the CATS network

Encouraging joint-working – including different clinicians contributing to a single episode of care.

Developing clear pathways between NHS 111 and the services incorporated into the CATS network

Driving efficiencies such as locating services in the same place, sharing of workforce and assets.

Ensuring that there are arrangements in place to support the warm transfer of calls between clinicians operating within the virtual CAT network.

Priority areas for developing integrated care

Mental Health

Improving how we identify people with a mental health issue so there is a clear pathway from

NHS 111 and the integrated CATS to a mental health clinician.

Intermediate care

What is intermediate care? If you no longer need hospital care but still need support living at home or in a care home, you will receive intermediate care. Similarly, if you are at risk of needing a trip to hospital when you could get help safely at home, intermediate care can be provided to help you avoid this.

The new service will work closely with intermediate and community care services so if you

ring NHS 111 with an intermediate care need you get the care you need.

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In-hours, the priority will be to ensure, if appropriate, you are sent to a community

intermediate care specialist first time and that if they are transferred from a CATS clinician

they are not re-assessed or re-triaged.

During the out of hours period, staff at the CATS need the relevant skills to help mitigate the

risk of hospital admission. The service also needs to ensure a booked appointment with the

rapid response team in-hours.

End of life/palliative care

The new NHS 111 service will need to work with SPAs where they exist

In the out-of-hours period, or in areas where there is not a single point of access for palliative

care, CATS or other urgent care services will help in the most appropriate way and will have

access to your care plan where you have given consent.

Whole Systems Integrated Care

What is Whole Systems Integrated Care (WISC)? WISC is one of the most important programmes running across NW London to join up care. Over 30 organisations, community groups and lay partners have come together to develop a vision for Whole Systems Integrated Care (WSIC) across North West London. The key principles are:

People will be empowered to direct their care and support and receive the care they need in their homes or local community.

GPs will be at the centre of organising and coordinating people's care.

Our systems will enable and not hinder the provision of integrated care. You can read more here: http://integration.healthiernorthwestlondon.nhs.uk/about-us

As part of the Whole Systems Integrated Care programme across North West London, GPs

will be actively identifying patients at the highest-risk of ill-health, working with them to

develop care plans and then actively managing those care plans to support patients to

remain independent for longer.

Discharge from integrated urgent care services

Any Urgent Care Service linked into the CATS will send details of all consultations (including

appropriate clinical information) to the practice where you are registered.

http://integration.healthiernorthwestlondon.nhs.uk/about-us