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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