ArchnaMathur, Director of Performance and Quality NHS Tower Hamlets CCG, Selina Douglas Deputy Chief Officer Newham CCG and Henry Black Chief Finance Officer NHS Tower Hamlets CCG attended to discuss the report which provided an overview of NHS 111 Integrated Urgent Care (IUC) procurement.  Ms Mathur provided an overview of the intended procurement for NHS 111; which was to be rolled out in February 2018.  Service specification and vision for the wider IUC services were presently under consideration.

 

The Committee was informed that the 111 service:

·         concept was born out of work carried out in 2014 and aimed to ease pressures in the system. The PowerPoint presentation circulated in the agenda set out how the services will mirror the sustainability and transformation plan (STP).

·         was intended to address access to health care issues in the context of significant population growth, significant challenges faced by Accident and Emergency (A&E)  Departments and Ambulance services, difficulty in accessing emergency services quickly and patient confusion about when best call 999, GP or other healthcare services.

·         was intended to deliver more accessible seven-day primary care and fulfil national priorities.

·         would comprise: 111 helpline, out of hours services, extended primary care, urgent care in hospital and urgent community response. 

·         vision was to provide better access to the named services by providing a single contact number.  Patients would be able to speak to clinicians earlier than present arrangements allowed and receive appropriate triage for the services required by the caller based on early access to advice.  An additional benefit would be the economies of scale available through the single service model.

·         would be regulated through targets and performance monitoring to ensure that pressure on A&E services was better managed. 

·         call-takers’ role would be to establish the patients’ circumstances, verify them and make an appropriate onward referral.  Noting that feedback from the survey of the general experience of those using the NHS 111 service was mixed, the Inner North East London model therefore would include call-back targets of 15 minutes and this would be tested in undertaking the procurement for the services.

 

In summary the NHS 111 IUC Service would form the first port for telephone emergency access and involve assessment for appropriate onward referral to clinical or other services.  This Service would create a central point of delivery were clinicians, doctors and other professionals were available to give advice.

 

The Committee considered the report and Dr Jones’ submission and this was followed by questions and comments from Members.  Ms Mathur representing the CCG responded to Members’ questions.  These are summarised below and attributed to Members of the Committee at their request:

 

Questions, Comments and observations:

 

Publicity and Communications

Ms Mathur responded to Councillor Masters’ questions regarding:

• how the service would be publicised to hard-to-reach groups and non-English speakers. She informed the Committee that this matter had also been raised elsewhere and this question will be referred back to the project group.

 

• how the service would respond to speakers of other languages. She informed the Committee that a language line will provide immediate translation via a three-way conversation between translator professional and caller.

 

Ms Mathur responded to Councillor Harrisson’s question regarding why the Somali community was not using the 111 Service as indicated in the consultation with community groups. She informed the Committee that it had not been well advertised but the effects of the decision to implement locally and nationally at the same time had been recognised.

 

Councillor Akthar queried whether patients were not using the 111 Service because they didn't know that it was possible to call this number for emergency matters.  Ms Mathur acknowledged that effective communication was very important.  It was necessary to enable 111 callers to understand that an out-of-hours call to 111 or to 999 would deliver the same service on assessment.

 

Councillor Akthar noted that should this service be accessed during normal hours, this would be a waste of money.

 

Ms Mathur responded to Councillor Potter’s question regarding what sites had there been community engagement in the City and Hackney. She informed the Committee that this information was not available at the meeting but a response would be provided to Members.

 

Action by: Ms Mathur, Director of Performance and Quality NHS Tower Hamlets CCG

 

Potential Risks of the Service

Ms Mathur responded to Councillor Munn’s question regarding how (since the provision was intended for out of hours urgent and emergency circumstances) it could be ensured that callers would not use the 111 IUC services to obtain earlier appointments with their own GP.  She informed the Committee that a callers’ first point of referral would always be the GP surgery.  However the 111 IUC service would be applied in circumstances where a caller was unable to access their own GP surgery and the matter was urgent.  The purpose of the service was not to create demand but to manage patients’ direct self-referrals to hospital A & E. It was intended that care services will deal with relevant onward referrals.

 

Ms Mathur responded to Councillor Munn’s question regarding how demand would be managed and clients prevented from circumventing the system for a GP appointment. She acknowledged that this was a possibility and would be managed by conveying appropriate messages to callers that regular GP services should be accessed in the first instance.

 

Councillor Munn noted that Hackney health service already operated a call handling arrangement for out-of-hours services. Ms Mathur agreed to investigate what was provided and respond to the Committee.

 

Action by: Ms Mathur, Director of Performance and Quality NHS Tower Hamlets CCG

 

Ms Mathur responded to Councillor McAlmont’s query regarding whether over-75s and under-twos would be safe under the new service, since these vulnerable groups exited the current arrangements.  She informed the Committee that these groups would continue to be safe as they would be immediately spoken to by a GP.

 

Councillor Hayhurst noted that the proposals would be a step down from the services already provided since in Hackney out of hours calls are responded to by GPs and Hackney A&E services were excellent.  In his view:

·         The proposal was a step down.

·       He was surprised, given the current provision enjoyed, that Hackney services would support the proposals for IUC services.

 

Ms Mathur responded to Councillor Munn’s query whether healthcare professionals would be the first point of contact for all callers. She informed the Committee that there would be a number of trained call handlers to act as first point of call.  This is why there will be other clinicians present also to take calls.  During the assessment there will be referral to a wider clinical team.

 

Financial Matters

Ms Mathur responded to Councillor Munn’ question regarding how would savings be ensured. She informed the Committee that the new service would reduce costs by reducing inappropriate A and E use and by ensuring  that as many 111 callers as possible have answers to their issues earlier in that process thereby saving trips to and the resources of hospital A & E.

 

Transitional Matters

Councillor Munn enquired how much contact had there been with GPs in relation to establishing confidence about booking GP appointments through the 111 service.

 

Ms Mathur responded to Councillor Potter’s query concerning from where GPs for this service would be sourced. Ms Mathur noted the retention and recruitment issue, informed the Committee these would be sourced through consolidation of existing GP service.  It was noted that there were some concerns about numbers realistically; however the STP intended to address these.  Also because other clinicians would be involved (e.g. pharmacists to respond to calls about medications) there was scope to answer calls appropriately and such skills could give better suitability.

 

Councillor Munn noted that the proposals assume that the choices service operates.  She also commented that in her view it would be appropriate to look at what already exists and how this could be integrated into the new provision.  Ms Mathur responded that the CCG was in negotiations with City and Hackney to this end.

 

Ms Mathur responded to Councillors Munn and Councillor Mustaquim’s enquiry about:

• timescales
• whether implementation would be phased in or ‘big bang’ approach.
• how this implementation would be delivered without interrupting quality of services.

She informed the Committee that the new service would begin in February 2018.  All new services will be implemented at that time on the basis that the Provider has had learning and has made provision for the transfer to the new arrangements.  A test will be added to the staff procurement procedure in this regard.

 

Purpose/objectives of the new service

Ms Mathur responded to Councilman Mead’s question whether the proposed service just a rebranding of NHS direct service. She informed the Committee that the new service would give more flexibility and enable calls to be referred back to GPs.

 

Ms Mathur responded to Councillor McAlmont’s query on whether there will be sufficient resources to ensure that respondents would be able to speak to an appropriate professional for their issue (he contrasted the current circumstances of numbers waiting to speak to a GP).  She informed the Committee that the service would be appropriately resourced.  The minimum number of professionals present would be; one GP, one paramedic and one nurse.  If it were possible to resource calls through a wider hub, then they could be better referred to the appropriate local hub to ensure that confidence remains high.  Therefore the service would be resourced from across seven CCGs of N E London to ensure that the workforce was sufficient to make the proposed system resilient.

 

Ms Mathur responded to Councillor Munn's question concerning whether it was intended that there would be one or multiple providers to deliver one service across the inner in north-east London area. She informed the Committee that the procurement was for one provider for 111 calls across the seven CCG's of the inner North-East London area.

 

Ms Mathur responded to Councillor Hayhurst regarding whether present GP out of hours telephone numbers would be replaced by the new service.  She informed the Committee that the new 111 Service would replace all current contact numbers for out-of-hours primary care. It was intended that the new provision would build more resilience into each local system and future proof the provision. However, where clients needed a face-to-face service this will still be delivered locally.    Councillor Hayhurst noted that the present arrangements in Hackney had been rated very good and was concerned that the proposed change would result in a deterioration of the good provision currently enjoyed by Hackney residents and would be detrimental for Hackney residents.

 

Performance

Ms Mathur responded to Councillor Harrisson’s question regarding whether feedback was already embedded in the system.  She informed the Committee that a feedback system was already in use and already embedded.

 

Ms Mathur responded to Councillor McAlmont’s query on whether the call-back targets were achievable. She informed the Committee that the targets were met and standards for responses were built into the metrics.  The average call-back time was eight minutes.  Additionally, since services would have greater resources, there was confidence that call-backs would be timely.  Referring to the submission from Ms Clark, Ms Mathur advised also that the new service would provide greater capacity to meet needs.

 

Concluding Comments

Ms Mathur advised:

• That the current consultation was almost complete and there were points to take back from the JHOSC engagement but the proposals will consider the area's wishes.
• That the time that remained until the closure of the consultation in February 2017 would enable the INEL JHOSC. Members to take matters of interest and contention back to be discussed by their own local authority.

 

The Chair confirmed that there would be matters that each local authority representative wished to take back and to discuss with their own area health scrutiny bodies

 

The Chair thanked the CCG representatives for their presentation and report.

 

RESOLVED

 

1.         That the report presented and discussion on the overview of NHS 111 integrated urgent care procurement be noted

2.         That that issues raised at the meeting relating to specific local authority matters be referred back to the originating local authority by be relevant INELJHOSC Member.

3.         That any further local comments be referred back to the CCG by the consultation closing date of 28 February 2017