NHS 111 First
Decision Maker: Health Scrutiny Committee
Decision status: Recommendations Approved
Is Key decision?: No
Report on the new national NHS 111 first
programme and the phased approach to its rollout across the North
The Chair welcomed Dr Amanda Doyle, GP and Integrated Care Strategy lead for Lancashire and South Cumbria and Jackie Bell, Head of Service for 111, North West Ambulance Service NHS Trust. A report outlining the process and implementation of the new NHS 111 First initiative was presented
The following points were highlighted:
· The new appointment system for those who would normally self-present at A&E supported social distancing and aimed to reduce overcrowding, waiting times and subsequently COVID-19 infection rates. The new system would support a better flow of work, made best use of available technology and should improve clinical outcomes, as all attendees will have had a remote assessment prior to their A&E appointment. The clinician carrying out the assessment would book the most appropriate appointment depending on the issue and the service user would not be required to re-dial another service. It was emphasised that the new way of working was not for urgent 999 calls and life threatening situations. A&E self-admissions represented approximately 60% of the A&E intake.
· The new system had been launched in Blackpool and Warrington with Royal Blackburn to follow in October. These initial launches were to assess effectiveness and outcomes, to make any necessary amendments prior to the national campaign launch which would communicate the new process of ringing 111. By the end of November all A&E departments would be live with the system. Feedback so far from patients and staff had been very positive and hospitals were keen to launch the programme to prepare for winter.
· The aim was for 20% of self-referrers to access 111 First, however initial monitoring indicated that the uptake would be higher. Therefore it would be a significant challenge to ensure the recruitment of health advisers and assessment clinicians was sufficient to support demand. Recruitment for health advisers was on schedule.
· The clinical assessments would be at a local level to ensure the most appropriate services for the area were signposted.
In response to questions from members the following information was clarified:
· There had been a significant and sustained pressure on the 111 service, related to calls about access to testing rather than in relation 111 First. The messages on testing websites were being changed to reduce these calls. Blackpool had been identified for an initial launch as an area that made low numbers of calls to 111 but had high presentations at A&E.
· Staff with experience of 111 First and all patients ringing 111 who were subsequently booked in to a service were being surveyed. Once more sites were live the feedback results would provide a more robust and effective base for sound evaluation.
· As a national programme, the service would be centrally funded. Additional capital funding to house additional staff resource would also be required. It was anticipated that the programme would eventually yield savings once firmly established.
· Staff numbers would be increased for the additional calls and work was underway with the estates team to undertake rapid expansion of office space to accommodate them. However due to numbers of staff working from home some extra office space was immediately available.
· The service would cover the whole of the North West Ambulance Service Trust area, with the initial call being taken at a centralised location. However clinical assessment would be at a local level. There was a mandatory six week training course for health advisers (111 call takers), which resulted in staff following an algorithm designed by clinicians for non-clinical users. Following that, new staff were individually mentored for two weeks. Rigorous standards were followed and staff were provided with regular feedback regarding the quality of their calls. The training was firmly embedded and outcomes were audited.
· If a GP appointment was booked this was done in real time. However some surgeries were asking for a list to enable them to call back the patient to book the appointment, dependent on surgery procedures regarding infection control.
· It was not usual for someone with a need that could be met by social prescribing to present to A&E, however the clinical assessment would determine if social prescribing was the appropriate pathway for the call.
1) The report regarding the implementation of the national NHS 111 First programme, as presented, be noted.
2) The findings and evaluation of the new NHS 111 First programme be presented to the Health Scrutiny Committee in six months' time.
Report author: Gary Halsall
Date of decision: 15/09/2020
Decided at meeting: 15/09/2020 - Health Scrutiny Committee