COVID-19 has forced through many significant changes to health and care that should have happened years ago. One example is the rapid development of NHS 111 First which is currently being piloted in Hampshire and Cornwall.
Launched in 2014, NHS 111 is the free-to-call single non-emergency number medical helpline operating in England, Scotland and parts of Wales. NHS 111 First takes this one step further, ensuring that patients have access to either a telephone or online consultation prior to an appointment slot being given at an emergency or acute department – essential to ease the pressure on the NHS during peak times such as winter – and of course pandemics.
COVID-19 has been a key catalyst to drive this next step in NHS 111 which arguably should have happened when the service first launched. So how can we sustain this important and positive step forward?
For NHS 111 to truly be the first point of access into health care a number of critical things need to happen:
The service must have adequate resource to ensure all calls are rapidly answered and effectively triaged as this will prevent patients seeking advice elsewhere in the system. It is estimated there is currently a shortfall of 80 full time clinicians within NHS 111/IUC services and this will not be addressed by endless recruitment campaigns. It will require services to join up and work together so as to create economies of scale, capitalising on areas where recruitment is plentiful and not in stiff competition with the other call centres in the close vicinity. This has been clearly demonstrated with the Returning Clinicians COVID Clinical Assessment Service (CCAS) that was set up to support COVID patients – a single multi-discipline clinical workforce that is not geographically restrained.
It is critical that the other wraparound and supporting services are available for extended hours, otherwise, again, the default position for patients will be 999 or the Emergency Department (ED). Community services infrastructure needs to be robust enough to manage surges, support NHS 111 with a range of services that can rapidly assess a patient and provide additional support and time if required, and all easily available on the Directory of Services – a Saturday should be same as a Tuesday and 3pm should be same as 3am. ED and 999 should not be the default option for patients simply due to the time of day.
We must embrace direct booking in primary care and continue the COVID practice of telephone consultations prior to a face-to-face so that the most unwell patients have access to the GPs, including those in care homes.
Summary care records need to be shared with all relevant parties to really enhance the care patients are receiving and prevent them having to repeat their stories multiple times. Delivery and use of integrated care records is still patchy in some areas, although in others such as Bristol, North Somerset and South Gloucester (BNSSG), who have the Connecting Care programme, the connection with social care works really well.
We must maximise the treatments taking place at urgent treatment centres (UTC) and minor injuries units (MIU) – in fact should all MIUs now see minor illness in support of primary care?
Loop holes in the system need to be closed where possible. NHS 111 call handlers currently are able to transfer calls to 999 services following clinical triage but the 999 service is not able to transfer back the other way to 111 services. Enabling this would allow patients to get to the right service appropriate for their need rather that receiving a conveying resource as nothing else is available for the ambulance crews.
Mental health has to be a fundamental part of the NHS 111 First solution, and those in need of urgent mental health support should be able to talk to specialist clinicians and therapists based in 111 services. This will mean that the crisis lines are freed up for individuals who are truly in need of immediate care, while those who would normally have ended up taking themselves to ED or calling 999 are “held” by trained professionals and supported to find a more appropriate next step. 24/7 crisis lines have been made available for both Children and Young People (CYP) and adults as part of the COVID response – it’s time to start differentiating between urgent and crisis mental health care.
We know from COVID 19 that certain communities and demographics have been harder hit than others, so let’s use the population information now to understand the communities and how urgent care planning and NHS 111 developments can be differentially targeted. This will help ensure equality and diversity of access is a reality for all communities and patients are supported in the best way regardless of religion, disability, gender, sexuality or diagnosis.
Let’s not allow the learning and development during the pandemic to go to waste.