NHS 111 Service Specification

NHS 111 Service Specification NHS 111 Programme Version 2.8 November 2011

Document control Audience Document Title Document Status NHS 111 programme and stakeholders NHS 111 Service Specification Approved by programme board Document Version 2.8 Issue Date November 2011 Prepared By NHS 111 Programme team Version Date Name Comment 0.1 11/12/09 Steve Vine Outline draft 0.2 18/12/09 Steve Vine Incorporating comments and content from DH 3DN team and CfH 0.3 23/12/09 Steve Vine Additional comments from DH and CfH 0.4 04/01/10 Steve Vine Nicholas Reeves review 0.5 08/01/10 Steve Vine Draft released for review by pilot areas 0.6 14/01/10 Steve Vine Final draft for pilot area review 0.7 20/01/10 Steve Vine Final draft for programme board 1.0 01/02/10 Steve Vine Approved by programme board 1.1 01/03/10 Steve Vine Incorporating minor updates and clarifications 1.2 17/05/10 Louisa Bates No changes new version number only 1.4 Dec 2010 Steve Vine Outline revision for pilot expansion 1.5 Jan 2011 Michele Armstrong Updates to core principles 1.6 Apr 2011 Steve Vine First draft revision for expansion of pilots and wider roll-out 1.7 May 2011 Steve Vine Revised draft incorporating initial NHS feedback for approval by NHS 111 Operations Board 1.8 May 2011 Steve Vine Incorporating feedback from NHS 111 Operations Board 2.0 Jun 2011 Steve Vine Approved by NHS 111 Programme Board 2.5 Nov 2011 Diane Baynham Revised version incorporating clarification points for approval by NHS 111 Operations Board. 2.7 Nov 2011 Diane Baynham Revised version following NHS 111 Operations Board feedback 2.8 Nov 2011 Steve Vine Approved by programme board Att L - App3 - NHS 111 Service Specification v2 8 Page 1 of 20

Contents Document control 1 Contents 2 1 Introduction 4 1.1 Purpose 4 1.2 Audience 4 1.3 Background 4 1.4 Status 4 1.5 Change control 4 1.6 Related documents 4 1.7 Structure 5 2 Overview 6 2.1 Vision 6 2.2 Success 6 2.3 Scope 6 3 Core principles 7 3.1 Summary 7 3.2 Completion of a clinical assessment on the first call without the need for a call-back 7 3.3 Ability to refer calls to other providers without the caller being re-triaged 7 3.4 Ability to transfer clinical assessment data to other providers and book appointments where appropriate 7 3.5 Ability to dispatch an ambulance without delay 8 4 National and Local Responsibilities 9 4.1 National responsibilities 9 4.2 Local responsibilities 9 5 Quality assurance 10 5.1 Clinical governance 10 5.2 Minimum datasets 11 5.3 Call handling and service delivery standards 11 5.4 Readiness testing 11 5.5 Ongoing quality assurance 11 6 Interoperability 12 Att L - App3 - NHS 111 Service Specification v2 8 Page 2 of 20

6.1 NHS 111 Interoperability Specification 12 6.2 Directory of Service interoperability 12 6.3 Interoperability specification future development 12 7 Statutory Duties 13 7.1 Protection and Retention of Information 13 7.2 Safeguarding and Promoting the Welfare of Children 13 7.3 Repeat Callers 13 7.4 Data sharing with Health Protection Agency 14 7.5 Care Quality Commission 14 8 Technical requirements 15 8.1 DDI numbers 15 8.2 Recorded messages 15 8.3 Call recording 15 8.4 Incoming lines and call queuing 15 8.5 Business continuity and disaster recovery 15 8.6 Service usage reporting 15 A Glossary and definitions 16 B NQR 9 17 C NQR 2 18 D NHS 111 Core Values 19 Att L - App3 - NHS 111 Service Specification v2 8 Page 3 of 20

1 Introduction 1.1 Purpose This document describes the key principles and features of the NHS 111 service and serves as the high level specification for the expansion of the pilot phase and wider rollout of the 111 service. It has been co-produced by the DH and the NHS and is governed by the NHS 111 Programme Board. 1.2 Audience The primary audiences for this document are NHS commissioners and partners preparing to deliver the NHS 111 service in their local area, and the DH team who are responsible for providing nationwide services such as call routing and marketing. 1.3 Background The NHS 111 service is specified nationally so that a consistent identity and quality of service is maintained across the country, and delivered locally by the NHS in a way that is most appropriate for any given area. Version 1.0 of the NHS 111 Service Specification was developed to support the pilot phase of the NHS 111 programme. This version of the specification supersedes all previous versions and has been updated in light of lessons learned from the live pilots and also to reflect the more permissive approach to extending the service, allowing for a wider range of operational models. 1.4 Status Draft for approval by the NHS 111 Programme Board. 1.5 Change control Future changes to the national NHS 111 Service Specification as a result of either service development or other necessary changes will require approval by the NHS 111 Programme Board and subsequently an NHS body yet to be determined. 1.6 Related documents This document should be read in conjunction with the following: National Quality Requirements In the Delivery of Out-Of-Hours Services: Sets out the call handling and quality standards for out-of-hours (OOH) operations NHS 111 Minimum Dataset - Commissioners Version and NHS 111 Minimum Dataset Providers Version NHS 111 Interoperability Specification: Sets out the interoperability requirements for sharing 111 information Att L - App3 - NHS 111 Service Specification v2 8 Page 4 of 20

1.7 Structure The remainder of this document is structured as follows: Section 2 Overview: sets out the vision, aims and an overview of the NHS 111 service Section 3 Core principles: sets out the fundamental requirements for the NHS 111 service that underpin this specification Section 4 National and local delivery: sets out the scope and responsibilities at a national and local level Section 5 Quality assurance: sets out the requirements for clinical governance, service readiness and the minimum dataset Section 6 Interoperability: sets out the requirements for data sharing and interoperability Section 7 Statutory duties: sets out statutory requirements Section 8 Technical requirements: sets out additional detailed requirements not covered elsewhere in the document Annex A Glossary: covering definitions and abbreviations used throughout Annex B NQR 9: provides background on how the 111 service relates to NQR 9 Annex C NHS 111 Core Values: sets out the NHS 111 core values Att L - App3 - NHS 111 Service Specification v2 8 Page 5 of 20

2 Overview 2.1 Vision NHS 111 TRANSFORMING ACCESS TO URGENT HEALTHCARE The NHS 111 service will make it easier for the public to access urgent healthcare and will drive improvements in the way in which the NHS delivers that care. 2.2 Success The primary aims of NHS 111 are to: Improve the public s access to urgent healthcare Help people use the right service first time including self care Provide commissioners with management information regarding the usage of services Achieve national coverage in England by April 2013 2.3 Scope NHS 111 is being introduced to make it easier for public to access urgent healthcare services. The free to call 111 number is available 24 hours a day, 7 days a week, 365 days a year to respond to people s healthcare needs when: you need medical help fast, but it s not a 999 emergency you don t know who to call for medical help or you don't have a GP to call you think you need to go to A&E or another NHS urgent care service you require health information or reassurance about what to do next Calls are answered by highly trained advisers, supported by experienced clinicians, who assesses the caller s needs and determine the most appropriate course of action, including: callers who can care for themselves will have information, advice and reassurance provided callers requiring further care or advice will be referred to a service that has the appropriate skills and resources to meet their needs callers facing an emergency will have an ambulance despatched without delay callers requiring services outside the scope of NHS 111 will be signposted to an alternative service The NHS 111 service also provides management information to commissioners regarding the demand for and usage of services in order to enable the commissioning of more effective and productive services that are designed to meet people s needs. Att L - App3 - NHS 111 Service Specification v2 8 Page 6 of 20

3 Core principles 3.1 Summary NHS 111 operates according to the following core principles: Completion of a clinical assessment and information on the first call without the need for a call back Ability to refer callers to other providers without the caller being re-triaged Ability to transfer clinical assessment data to other providers and book appointments where appropriate Ability to dispatch an ambulance without delay These are the fundamental requirements that underpin the NHS 111 service. 3.2 Completion of a clinical assessment on the first call without the need for a call-back Calls should be handled and, where appropriate, clinically assessed by the person who initially answers the call. If a clinician is required to complete the clinical assessment, the call should be warm transferred (the call-adviser speaks to the clinician and then transfers the call without any call back). In exceptional circumstances where a clinician is not available, the caller should be called back by a clinician within 10 minutes. Where a caller requests health information and has no symptoms for assessment, then the nature of the request should be explored in detail and a timescale for call back should be agreed within the initial call. 3.3 Ability to refer calls to other providers without the caller being re-triaged Callers to NHS 111 should be clinically assessed once and, where appropriate, referred to the provider that is best placed to meet their needs. Referral protocols should be in place with providers setting out the arrangements for passing data and transferring responsibility for the care of the patient. The aim is to maximise understanding within the receiving service and minimise the need for the caller to repeat details. The NHS 111 provider always has responsibility to report the initial encounter with the NHS 111 service to the GP in order to meet NQR 2 standards, but the provider who last provides care and/or signposting advice following the NHS 111 referral should also report the resulting patient encounter to the GP. Patient records shall be matched to the spine via Patient Demographic Service (PDS). 3.4 Ability to transfer clinical assessment data to other providers and book appointments where appropriate Callers requiring in-hours GP services will be advised to contact their GP directly and advised that, if their GP is unavailable within the suggested timeframes, they should call NHS 111 again to find an alternative service to meet their needs. Callers requiring another primary care service, including the GP OOH service, should have an appointment booked by the NHS 111 service where possible, and their clinical assessment details sent to that service. Att L - App3 - NHS 111 Service Specification v2 8 Page 7 of 20

3.5 Ability to dispatch an ambulance without delay Where the clinical assessment of a 111 caller indicates that the dispatch of an ambulance is appropriate, the NHS 111 adviser should be able to dispatch an ambulance without any delay or re-triage of the call. Where clinically appropriate, the adviser should stay on the line to provide advice and support prior to the vehicle arriving. Where the clinical assessment of a 111 caller indicates that the dispatch of an ambulance is appropriate, but the caller s location is unknown, the advisor should ask the caller to hang up and redial 999 themselves, thereby ensuring that their call reaches the right ambulance service who will have immediate access to their location information. Att L - App3 - NHS 111 Service Specification v2 8 Page 8 of 20

4 National and Local Responsibilities 4.1 National responsibilities The following aspects of the service are provided on a national basis. Currently these are the responsibility of the DH: Provision of a memorable, free to call, three digit telephone number 111 Provision of national telephony infrastructure that routes calls made to 111 to the appropriate NHS 111 operation Management of the NHS 111 identity, core values and the provision of guidelines Development of the marketing campaign for the NHS 111 service Provision of an NHS 111 training module covering core values and service culture Readiness testing of NHS 111 operations against the NHS 111 Service Specification prior to launch Approving the quality of clinical governance arrangements prior to launch Quality assurance of NHS 111 operations on an ongoing basis Management of relationships with national stakeholders in the NHS 111 service including media handling Management and governance of the NHS 111 Service Specification to incorporate any changes and service developments 4.2 Local responsibilities The following aspects of the NHS 111 service are provided on a local basis in a geographic area. Currently these are commissioned by PCTs: Implementation and operation of the NHS 111 service including call handling, clinical assessment and onward referral to other healthcare services according to the NHS 111 Service Specification Maintenance of an up to date directory of local services and referral protocols with service providers Provision of management information to commissioners regarding the demand for and usage of services Clinical governance and quality assurance of the NHS 111 service locally Marketing NHS 111 locally in accordance with the national marketing strategy Incorporation of the NHS 111 training module into local training and development material Local stakeholder and media handling Business continuity and disaster recovery Att L - App3 - NHS 111 Service Specification v2 8 Page 9 of 20

5 Quality assurance 5.1 Clinical governance Clinical governance arrangements must be in place to ensure the clinical safety of the whole patient pathway, not just the NHS 111 call handling service. Strong relationships and partnership working should be established between all providers involved in the pathway so that issues can be identified and service improvements made. Clinical governance arrangements should include: A local governance group, under strong clinical leadership and with clear lines of accountability to the commissioners of the NHS 111 service, which brings together the NHS 111 service itself with all the NHS and social care providers to whom patients may be referred, enabling all to develop a real sense of ownership of their local service Clarity about lines of accountability within the NHS 111 service, from the Senior Responsible Officer through to individual members of staff within the NHS 111 service and its partner provider organisations, and about the manner in which the clinical governance of the NHS 111 service engages with and supports the governance arrangements in provider organisations A robust policy setting out the way in which adverse and serious incidents will be identified and managed, ensuring that the clinical leadership of the NHS 111 service plays an appropriate role in understanding, managing and learning from these events, even where they have originated in a partner provider organisation Detailed knowledge of the different stages in the patient s journey through the NHS 111 service, including an understanding of the way in which potential shortcomings at any stage in that journey will be identified Clear and well-publicised routes for both NHS 111 service users and health professionals to feedback their experience of the service, ensuring prompt and appropriate response to that feedback with shared learning between organisations, including feedback to the individual who was the source of the comment in the first place Regular surveys of patient and staff experience (using both qualitative and quantitative methods) to provide additional insight into the quality of the NHS 111 service Assurance by the NHS 111 clinical leadership of quality of the clinical support to call advisers including decision support systems, directory of services and clinical supervision Regular review by clinical leadership of the quality of the calls, especially where their outcomes have proved problematic, with involvement of other partner providers Regular staff training, and refreshing where required on updated policies and procedures, to ensure quality of service is maintained Provision of accurate, appropriate, clinically relevant and timely data about the NHS 111 service to ensure that it is meeting the quality standards set out in this specification Att L - App3 - NHS 111 Service Specification v2 8 Page 10 of 20

5.2 Minimum datasets The commissioner and provider NHS 111 minimum datasets must be populated so that information and intelligence is provided to commissioners to inform the ongoing design and place of NHS 111 in their urgent care service. The datasets will also be used to monitor and report on the performance of the service. The NHS 111 minimum datasets will collect the following information Provider / Process including volume, access, dispositions Costs including cost per call, staff mix, non-staff costs Experience including satisfaction, compliance, health outcome, services used System impact / Volume changes including A&E, WiCs, MIUs, UC centres, GPOOH, Ambulance The detailed content of these datasets is set out in the documents NHS 111 Minimum Dataset Commissioners Version and NHS 111 Minimum Dataset Providers Version. 5.3 Call handling and service delivery standards Providers must meet the standards set out in the National Quality Requirements for the Delivery of OOH Services. A further explanation of how NQR9 should be applied is provided in Annex B. In summary, Providers will need to report on the following to ensure compliance with NQR 9: How many call backs are made (during the initial clinical assessment) and how long after the attempt to warm transfer the call was the call back made Compliance with the timescales set by the original clinical assessment eg if the disposition was for the patient to be called by a clinician within the next 24 hours, whether this was met or not Providers of information following a period of research should ensure their information provision meets quality standards laid out by The Information Standard. Providers should also incorporate the NHS 111 training module on core values into their own training programmes. See Annex C for an overview of the core values. 5.4 Readiness testing Readiness testing will be carried out to assure the quality of service prior to launch of the NHS 111 service in a given area. It will incorporate: Reviews of plans and progress during service development and implementation against the NHS 111 service specification Live simulation of end-to-end NHS 111 processes from call handling through to partner service providers to test for readiness against the service specification Review of the clinical governance arrangements against the requirements set out in the NHS 111 service specification 5.5 Ongoing quality assurance The ongoing arrangements for quality assurance are still to be agreed and are expected to be based on the minimum dataset and requirements of the 111 Service Specification. Att L - App3 - NHS 111 Service Specification v2 8 Page 11 of 20

6 Interoperability 6.1 NHS 111 Interoperability Specification Interoperability within the NHS 111 environment is detailed in the NHS 111 Interoperability Specification. The specification covers the mechanism for all the transfer of outcomes from clinical decision support systems in NHS 111 call handling organisations to the various health service providers including ambulance trusts and OOH services. This can be in the form of: Ambulance despatch Clinical assessment data Patient data The specification details the message format that is used for all of these interactions. This means that any supplier involved in NHS 111 will need to be able to at least receive this message and possibly send depending on the part they play. Patients should be matched to the spine via Patient Demographic Service (PDS) before electronic transmission. This specification is based on international standards and in line with the interoperability toolkit. 6.2 Directory of Service interoperability Access to directory of service solutions will also be detailed as part of the NHS 111 Interoperability specification. This details the standard interface that must be implemented in order to communicate with the relevant directory of service which contains those services commissioned by the NHS against the outcome and disposition codes from the clinical decision support system. 6.3 Interoperability specification future development Work is currently on going to enhance the scope of the Interoperability Specification to include the following: Alignment of web services standards to (ITK) (Interoperability Toolkit) Creation of central directory for keeping the information about all the end points to be used in message addressing Including the directory of service interface specification as part of the overall interoperability specification as an optional feature Evaluating options to design the specification to allow GP appointment booking Att L - App3 - NHS 111 Service Specification v2 8 Page 12 of 20

7 Statutory Duties 7.1 Protection and Retention of Information All NHS organisations have a duty under the Public Records Act to make arrangements for the safe keeping and eventual disposal of all types of their records in accordance with national policy. NHS organisations are required to have robust records management procedures in place to meet the requirements set out under the Data Protection Act 1998 and the Freedom of Information Act 2000 (Detailed guidance on all aspects of record keeping and protection of information can be found in Records Management: Code of Practice available at www.dh.gov.uk). 7.2 Safeguarding and Promoting the Welfare of Children 1 Section 11 of the Children Act 2004 places a duty on Strategic Health Authorities, Primary Care Trusts and other NHS bodies to safeguard and promote the welfare of children. Statutory guidance on this duty 2 is available at www.dcsf.gov.uk/everychildmatters. Commissioners must ensure that service providers have due regard to this guidance and that procedures are in place to safeguard and promote the welfare of children. Commissioners will also want to consider whether the service should be represented on the relevant Local Safeguarding Children Board(s) or alternatively ensure they are liaising with their SHA or PCT representative. 7.3 Repeat Callers As a result of the tragic death of Penny Campbell in 2005, the Department of Health issued Directions 3 requiring all GP Out-of-Hours services to ensure that any health professional assessing a patient s needs in the out-of-hours period would have access to the clinical records of any earlier contact that patient (or their carer) may have recently made with the service. While this principle was developed in relation to out-of-hours services, it is clearly just as important for an NHS 111 service to be aware of the fact that other calls have been made recently by or on behalf of that patient. Thus, where a patient (or their carer) calls the NHS 111 service 3 times in 4 days, the 3rd call should only be assessed by the call adviser to determine whether or not an ambulance is required. If the outcome is not to send an ambulance, 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 3rd time in 4 days 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. Where possible, the GP should be sent details of all 3 calls. 1 Section on safeguarding adults to be added 2 Statutory guidance on making arrangements to safeguard and promote the welfare of children under section 11 of the Children Act 2004; and Working Together to Safeguard Children: a guide to inter-agency working to safeguard and promote the welfare of children 3 THE PRIMARY MEDICAL SERVICES (OUT OF HOURS SERVICES) DIRECTIONS 2006, Department of Health, December 2006 Att L - App3 - NHS 111 Service Specification v2 8 Page 13 of 20

The host software system will have to be able to identify where a caller has called twice before within 4 days, so that it can then flag this third call in such a way that when it is answered by the call adviser, the outcome described above is achieved. 4 None of this should apply to that small minority of people who regularly make repeated calls to the same service, where the service will have made separate arrangements to respond appropriately to those calls, nor should it apply where there is an agreed care plan for the particular patient (e.g. palliative care, long term conditions etc.). The host software system will therefore also need to be able to identify these callers so that the NHS 111 service can respond appropriately to their needs. Providers should monitor compliance with the above requirement and report on any exceptions in a way that can be audited. 7.4 Data sharing with Health Protection Agency The Health Protection Agency s (HPA) aim is to protect the public from threats to their health from infectious diseases and environmental hazards. It identifies and responds to health hazards and emergencies caused by infectious disease, hazardous chemicals, poisons or radiation. The HPA uses sophisticated syndromic surveillance systems to monitor seasonal outbreaks of community-base infections (e.g. influenza and norovirus) and major public health incidents. These have proved their worth in monitoring such incidents as influenza A H1N1 in 2009. The agency s systems provide data in near real-time relating to the health outcomes of an incident. This is used to inform both policy makers at national and local level, and front line healthcare workers involved in providing clinical data. The syndromic surveillance systems rely on the automated supply of specified anonymised data from clinical information systems whose specification, transfer and use is governed by a Caldicott-compliant information sharing agreement between the HPA and the data supplier. This includes the NHS 111 service. The data capture necessary for the HPA s syndromic surveillance systems does not impose extra data capture requirements on the NHS 111 service over and above what is necessary to conduct a search of a directory of local services. These processes will be automated to ensure that there are no additional requirements imposed on the NHS 111 service providers. Every NHS 111 service will be required to: Enter into an information sharing agreement with the HPA for the secure supply of specified anonymised real-time data for public health surveillance purposes; Ensure that a data sharing agreement is included within contracts with providers of the NHS 111 service; and Ensure that appropriate governance arrangements are in place such that all NHS, third sector or commercial organisations participating in the NHS 111 service are enjoined in the commitment to supply the real-time specified data-set to the HPA. 7.5 Care Quality Commission Providers of the NHS 111 service must be registered with the Care Quality Commission. 4 At the time of writing options for a nationally provided solution are being considered Att L - App3 - NHS 111 Service Specification v2 8 Page 14 of 20

8 Technical requirements 8.1 DDI numbers Calls to 111 should be received on a specific DDI number that is devoted to 111, enabling calls directly to 111 to be counted. Calls to the NHS 111 centre which are redirected from other numbers (eg GPs or existing OOH numbers) should be sent to a different DDI. Calls to both DDI numbers can be treated the same and dealt with by the same staff using the same process and sit in a common queue. 8.2 Recorded messages Recorded messages should be compliant with the NHS 111 brand guidelines. 8.3 Call recording All inbound calls to 111 should be recorded. Calls from adults will be retained for 8 years and calls from or about children will be retained until their 26 th birthday. Providers are also required to ensure that systems are in place to comply with regulation concerning child protection and vulnerable adults. 8.4 Incoming lines and call queuing In order to cope with the very high level of demand that occurs on some days (such as boxing day) there should be three times the number of lines available compared to the maxim number of advisers. If the service runs out of lines then a technical error message is played by the system. Each destination can specify a maximum number of lines that are used by 111. When this maximum number of lines is used a standard message will be played indicating that the service is full. It is possible to amend the maximum number of lines that are used in an emergency. 8.5 Business continuity and disaster recovery As well as the standard destination (DDI) number for a provider a second destination number, preferably using a different network and/or different destination should also be available. It is the responsibility of the provider to ensure that other appropriate business continuity and disaster recovery steps are taken. 8.6 Service usage reporting Where the clinical assessment determines that the caller requires further advice or care from another service, providers should be able to report on which service the caller was referred on to. Att L - App3 - NHS 111 Service Specification v2 8 Page 15 of 20

A Glossary and definitions Term A&E DDI MIU NQR 9 OOH Explanation Accident and Emergency Direct Dial Inwards. Calls to different DDI numbers may be treated differently and reported on separately Minor Injury Unit Requirement 9 within the National Quality Requirements for the Delivery of OOH Services Out-of-hours Referral Re-triage Self care Signposting UCC Urgent healthcare Warm transfer WIC Passing of a patient between services where there is an agreed protocol for doing so covering the arrangements for sharing data and transferring responsibility Triage is the process of prioritisation. When a caller contacts 111 and is triaged as needing to receive services from a primary care organisation, it is up to that receiving organisation to determine how they provide services to that patient (e.g. GP phone consultation or GP clinic appointment). Re-triage is defined as a caller being re-assessed on receipt of the referral by a call adviser or clinician with a view to re-prioritising the patient Patients who can be advised how to manage their symptoms themselves without further contact with the health service unless their condition worsens or their symptoms persist for 3 or more days Directing a caller to another service that is outside the scope of NHS 111 and therefore no referral protocol exists Urgent Care Centre The range of healthcare services available to people who require or who perceive the need for medical advice, diagnosis and/or treatment quickly and unexpectedly A telephone call that is transferred from one individual to another (usually call adviser to clinician in the context of 111) while the caller is still on the line. The clinician acknowledges the transfer of the caller prior to the adviser backing out of the call Walk In Centre Att L - App3 - NHS 111 Service Specification v2 8 Page 16 of 20

B NQR 9 For the purposes of the original NHS 111 pilots, a clinical assessment by a properly trained and supported call adviser was regarded as the 'definitive clinical assessment' referred to in Quality Requirement 9. One of the objectives of the Sheffield University assessment of the original pilots is to establish whether these assessments are at least as safe and reliable as those completed by OOH clinicians. It follows therefore that the NHS 111 service will be fully compliant with Quality Requirement 9, provided that there are no call backs during the course of completing the clinical assessment. NQR 9 makes reference to the most urgent assessments being STARTED in 20 minutes and, by definition, where there are no call backs, this requirement will be met. If a call back is needed to complete the assessment, the call back must take place within 10 minutes, ensuring once again that NQR 9 is met. It is critical for the service provider to record precisely how many call backs there are and when they take place, so that the commissioner can ensure compliance with NQR 9. Where the outcome of the clinical assessment is that the patient needs to speak to a clinician with a defined period of time, the patient must end the call with a clear understanding of when they will be called back. In all circumstances, providers must record and report on their compliance with the timescales set in the original clinical assessment. Att L - App3 - NHS 111 Service Specification v2 8 Page 17 of 20

C NQR 2 For the purposes of National Quality Requirement (NQR) 2, there are 5 basic types of patient outcome that may result following an encounter with the NHS 111 service: a) Call is closed with no onward referral to another service provider. b) Call is referred for a face-to-face consultation. c) Call is referred for a telephone consultation. d) Call is signposted to another service provider. e) 999 response triggered. The NHS 111 provider always has responsibility to report the initial encounter with the NHS 111 service to the GP in order to meet NQR 2 standards, but the provider who last provides care and/or signposting advice following the NHS 111 referral should also report the resulting patient encounter to the GP, thereby providing an important opportunity to capture information about the full patient journey. To ensure the GP receives a consistent view for their patients and critically to ensure we transmit the correct patient demographic amongst the increased interoperability potentially across the wider urgent care network, spine compliance is required using the Patient Demographic Service to look up and validate patient demographics. Att L - App3 - NHS 111 Service Specification v2 8 Page 18 of 20

D NHS 111 Core Values CLARITY Our conversation and advice should be clear and understandable, using plain English and avoiding jargon and detailed medical terms, ensuring our callers are in no doubt about the advice or services we are providing. EMPATHY We need to ensure that anyone calling NHS 11 feels that they are treated as an individual and with respect, their problems are listened to and understood, regardless of race, age or gender. Our tone should never be patronising or dismissive, always positive and encouraging. RESOLVE We are determined to provide all our callers with an effective solution to their concerns. They should end the call with a clear plan of action of what to do next and a confidence that we have done everything we can to respond properly to their needs. Att L - App3 - NHS 111 Service Specification v2 8 Page 19 of 20