This paper explains the way in which part of the system is changing to become clearer and more accessible, beginning with NHS 111.

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1 Unscheduled care in Haringey 1. Introduction There have been many changes to urgent, unscheduled and unplanned care over recent years. To begin with Casualty departments became Accident and Emergency departments, Walk-In-Centres were introduced, NHS Direct began and GP practices provided out of hours care. Added to these we now have GP extended hours, GP out of hours provided by a single organisation, Urgent Care Centres, Minor Ailments Schemes, Major Trauma Centres, Stroke Centres and NHS 111. The above, in combination with factors affecting the way people want and expect to access healthcare, mean that what seems to have been a complicated system in the past has now become more complicated and needs to become clearer to all. This paper explains the way in which part of the system is changing to become clearer and more accessible, beginning with NHS NHS 111 The NHS 111 service is a new free NHS telephone number that will make it easier for the public to access local healthcare and will drive improvements in the way in which the NHS delivers that care. Calls will be assessed, advice given and if needed, patients will be directed to local health services. This could be Accident and Emergency (A&E), urgent care centre, an out of hours GP, community nurse, walk-in centre, emergency dentist or a pharmacy. The service will operate 24 hours per day, 7 days per week, 365 days per year and will replace NHS Direct and GP out of hours call centres. The benefits that the NHS 111 service is intended to provide include: Improving the public s access to urgent healthcare services (in line with assessed needs) Increasing the efficiency of the NHS Increasing public satisfaction and confidence in the NHS Enabling the commissioning of more effective and productive healthcare services that are tuned to meet people s needs Increasing the efficiency of the 999 emergency ambulance service. The new system is intended to cut out the multiple telephone numbers previously required and simplify the patient message. As NHS 111 operates 24 hours there will be a slightly different pathway between in hours and out of hours, this refers to usual opening hours of GP practices as being 8am to 6.30pm Monday to Friday. 1

2 The NHS 111 pathways are shown below: Haringey is included in the North Central London (NCL) NHS 111 pilot that comprises all 5 boroughs in the cluster, and will be implemented in parallel with re-commissioned GP out of hours services for all 5 boroughs. Following a robust procurement process, NCL has appointed London and Central West (LCW) Consortium to provide the pilot 111 service (NCL 111) from its North West London call centre for a two year period. The service started with a soft launch on 19 February 2013 when only outofhours calls were routed to NCL 111, with no public promotion of the 111 number. Public launch will follow in mid March 2013, when there will be increased communications on the service to both wider urgent health and social care providers and to the public. A London-wide marketing campaign promoting NHS 111 is expected to take place in summer 2013, when all areas are operational and the NHS Direct service has ceased nationally (this number is stopping in London on 21 March; from this point callers to will be redirected to call NHS 111). Both commissioners and the NHS 111 provider recognise that the NHS 111 service is a pilot and therefore the provider is required to approach delivery of this service in the spirit of joint learning and partnership working, to ensure full patient/other stakeholder benefits realisation. The winning bid was tested against rigorous clinical quality and financial criteria and was able to demonstrate: A commitment to delivering high quality clinical outcomes for patients 2

3 Robust processes and policies A clear understanding of the challenges as well as the opportunities presented by the service A clear financial model with transparent calculations including proposed cost per call rates modelled over the two year period A clear commitment to making sure that the service delivers value for money for the NHS over the two year period. As part of the contractual agreement, LCW are also committed to delivering on national and locally agreed key performance indicators (LCW NHS 111 KPIs are attached in appendix 1). Across the cluster, the NCL NHS 111 work streams and overarching Project Board structure have now been set up. From an implementation perspective, the Project Board has been established since February 2012 and has been meeting every month to progress NHS 111 roll out as well as the Directory of Services (DoS) preparation. The Directory of Services (DoS) is the central information directory of NCLcommissioned services which will provide the 111 call handler with real time information about services available to support a particular patient. The DoS is an enabler for 111 which allows the most appropriate community service, with capacity, with the correct skills and within a defined area to be identified. Real time information about capacity is inputted into the DoS by service providers and influences the information available to 111 call handler at any given time. For example, if an urgent care centre has really long waiting times or is closed, they can change their status on the DoS so that it won t come up as an option for 111 call handlers to send patients to and alternative options will be given. This approach ensures patients will not be referred to a service which is inappropriate, closed or does not have capacity. As part of the local governance structure a Clinical Governance group is now established as the roll out moves to implementation. All CCGs are members of this group and it provides a forum for clinical and management leads to discuss live issues and any operational problems. Since the soft launch started members of the Clinical Governance Group and NHS 111 team have been participating in daily situation report ( sit.rep ) calls with the Department of Health and NHS London. Daily situation reports will continue until all parties are confident that the service is clinically safe and operationally robust. The situation reports gather levels of activity to the service including number of calls answered, percentage of these calls which were triaged, the proportion of calls managed by a clinician and the number of calls requiring an ambulance dispatch. There is also a dedicated 111 Health Professional Feedback form that is designed and used to capture feedback from each part of the operational pathway as multiple organisations, people and processes are involved. LCW, as the operator, will continue to provide the reports on a daily basis, but monitoring calls will reduce to weekly when everything has settled down in due course. Operational policies are being agreed to acknowledge local operation. LCW will be reporting monthly on the national NHS 111 minimum data set (MDS) information and local KPIs and will participate in regular end to end service audits. This means that the entire patient pathway for beginning to end will be looked at and not the separate parts in isolation. 3

4 The dedicated project team is currently part of the Transformational Change directorate at the CSU (Commissioning Support Unit).The period immediately following service launch (until autumn 2013) is expected to continue to be intensive from both a clinical and non-clinical perspective, with a significant and continued focus on the clinical governance of the local service, management of all feedback, oversight of any incidents, co-ordination of end to end service audits and multi-disciplinary call reviews, monitoring and reporting to CCGs and evaluating the system wide impact of NHS 111 in north and east London. In the short term the project team within the CSU will provide additional support to CCGs, until the local NHS 111 service is bedded in. In future, CCGs can form a view on how to monitor the local service. It is likely that a combination of CCG level and cluster / sub-cluster level will give the most rounded view. Regular reports will be available that will be considered at both the Quality and Finance and Performance Committees. 3. New out of hours GP services contract in Haringey The GP out of hours service provides non-emergency out of hours GP cover between 6.30pm and 8am during weekdays and 24 hours at weekends and on bank holidays. The current provider of this service in Haringey is Harmoni (who also provide the service in Camden and Islington). This means that Haringey residents can currently take advantage of seeing a Harmoni GP face to face in the Camden, Islington or Hackney bases, as well as the Haringey base (the Laurels): Whittington Health (Islington), The Laurels Heath Centre (Haringey), St Pancras Hospital (Camden) The Homerton Hospital (City and Hackney). Harmoni also see patients in their homes. This contract is in place until 1 April In 2012, there were 10,212 calls from Haringey residents to the Harmoni out of hours GP service. 8,366 of these calls resulted in a face to face appointment at one of Harmoni s bases, the others received advice over the telephone from a clinician. The figures below show which base Haringey residents visited: 5,306 at the Laurels 2,527 at the Whittington 259 at St Pancras 274 at Homerton (Harmoni s Hackney base) As the current contract had reached the end of its term, the service has undergone reprocurement. Prior to the procurement process, Haringey took the decision to join Barnet and Enfield in the re-procurement. The procurement was undertaken by NHS North Central London on behalf of Barnet, Enfield and Haringey PCTs and used the same specification as the current contract. The successful provider, Barndoc, was confirmed at the NCL Joint PCT Boards on 31 January Barndoc, who already provide the service for Enfield and Barnet residents, were awarded a 2 year contract from 2 April 2013 March 2015.Barndoc are well underway with discussions with Harmoni to ensure a smooth handover. Barndoc will provide out of hours cover for the same hours as Harmoni (6.30pm and 8am during weekdays and 24 hours at weekends and on bank holidays). However, there will 4

5 be a change in how to contact Barndoc as this will be via the new 111 number and not via a direct number. The number of face to face bases will continue under the Barndoc contract. But the shared opportunity changes because the service provider now covers Barnet and Enfield, so Haringey residents will be able to see a Barndoc GP face to face at Enfield and Barnet s bases (Finchley Memorial, Edgware and Chase Farm hospitals), as well as Haringey s base (the Laurels Healthcare Centre). Barndoc will also see patients in their homes. Although the number of face to face bases remains, there will be a change for some members of the public who currently choose to see a Harmoni out of hours GP at the Whittington (av.7 patients a day), St Pancras or the Homerton. Even though there has been no change to the service specification, the outcome of the procurement process to secure the best provider going forward has meant that there is an operational change because the new provider covers Barnet, Enfield and Haringey as opposed to Camden, Haringey and Islington. Haringey patients will now be able to see a Barndoc GP at one of four face to face locations, or visit the GP-led Urgent Care Centre at the Whittington, North Middlesex, Chase Farm, Royal Free or Homerton. In addition, Camden and Islington are currently engaging with residents on proposed changes to their out of hours services. Their current out of hours GP face to face bases are the Whittington and St Pancras (with Harmoni). Camden and Islington are proposing to change their out of hours GP specification to potentially exclude face to face appointments with HarmoniGPs at the Whittington and re-provide them via the urgent care centres at Whittington and Royal Free, in addition to the Harmoni base at St Pancras. Under this pilot, patients who need an out of hours GP appointment whilst the urgent care centres are open (until 10pm on weekdays and 8am 10pm on weekends and bank holidays) would either be offered a home visit or an appointment at the urgent care centres, and be seen by urgent care centre GPs (not Harmoni GPs). Patients who need an appointment out of hours when the urgent care centres are closed (10pm 8.30am) would be offered a home visit or an appointment at the St Pancras Harmoni base only (with Harmoni GPs). Camden and Islington s engagement runs until 19 April Haringey will liaise closely with Islington colleagues as the model develops as this represents a good opportunity to streamline the use of GP expertise. 4. Engagement and communication Following the announcement of the new provider, the CCG met with the Chair of Haringey s Adults and Health Scrutiny Panel, to explain the new out of hours arrangements, including the change in face to face locations. To start the engagement process with residents, the CCG will attend the Haringey Adults and Health Scrutiny Panel to explain and discuss the wider changes to the unscheduled care system in Haringey, including the introduction of the new NHS 111 number, the new out of hours GP provider and what these changes will mean for residents. This scrutiny session is 5

6 taking place on Tuesday 5 March. The presentation is being led by the CCG with input from colleagues in the 111 team and from Barndoc. In addition to the scrutiny meeting, the CCG will work closely with the GP practices in the west of the borough to explain the changes so that they can inform their patients accordingly and make travel options advice available to all. Haringey CCG will also be working closely with Islington CCG and Barndoc to explore other options for the Whittington site e.g. the potential future use of the Urgent Care Centre at the Whittington. In terms of wider communications, there is a large public and stakeholder information campaign planned to promote the new NHS 111 number. This includes using a range of materials and different mediums to inform the public about the new number. The Commissioning Support Unit team will assist the CCGs with this campaign across north central London, closely linking with the CCG s communications lead who will make sure information is shared through local channels, including with the new Haringey Healthwatch organisation. Information about the new out of hours GP contract has also been shared on the CCG s website and with some key stakeholders, including Havco and Healthwatch. Activity shifts will be monitored closely as things progress to ensure the services remain in the right place - first time. 5. Conclusion The Governing Body is asked to note the changes to the unscheduled care system in Haringey, comment on the planned engagement activities and note the key performance indicators for the NHS 111 provider. 6

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