Agenda item

The Panel will receive a presentation on:

·        Changes to the unscheduled care system in Haringey, including the introduction of the new NHS 111 phone number

·        Change in provider for Out of Hours services in Haringey and what this means for residents.

Attendees

• Jill Shattock, Director of Clinical Commissioning, Haringey Clinical Commissioning Group (CCG)
• Dr John Rohan, Haringey GP and Haringey CCG Governing Body member (unscheduled care lead)
• Alison Blair, Senior Responsible Officer for the NHS 111 programme
• Sarah McIlwaine, Senior Programme Manager, NHS 111 programme
• Annette Alcock, Deputy Chief Executive, Barndoc
• Dr Anuj Patel, Medical Director, Barndoc
• Christine Callender, Director of Operations and Nursing, Barndoc

The Panel heard from:

·        Jill Shattock, Director of Clinical Commissioning, Haringey Clinical Commissioning Group (CCG)

·        Dr John Rohan, Haringey GP and Haringey CCG Governing Body member (unscheduled care lead)

·        Alison Blair, Senior Responsible Officer for the NHS 111 programme

·        Sarah McIlwaine, Senior Programme Manager, NHS 111 programme

·        Annette Alcock, Deputy Chief Executive, Barndoc

·        Dr Anuj Patel, Medical Director, Barndoc

·        Christine Callender, Director of Operations and Nursing, Barndoc

The Panel received an overview of the 111 and Out of Hours service.  The following points were noted:

111

·        The basic idea of 111 is to ensure that people access the right service at the right time – “Right First Time”.

·        111 is a national service.

·        Haringey is working with the other four areas in the North Central London cluster to set up a local version with local information.

·        The service is being rolled out in April 2013.

·        It is a free to call number for when you need medical help urgently but when it isn’t an emergency.  ‘Urgent’ is defined by the called when deciding whether to call 111 or 999.

·        111 calls are answered by call handlers, all of which are supervised by clinicians.   The call handlers assess the urgency of the call and look at best possible local services and how these can be accessed.

·        It is different to NHS Direct which stops at the end of March in London.

·        The aim of 111 is to deal with callers at the time of their initial call.  You can also be referred to another provider.

·        111 can send information to other providers e.g. GP surgery.

·        111 can send you an ambulance if needed.

·        At the time of the meeting the 111 service in Haringey was being tested ready for go live.  It is not yet being advertised as services which are not live can not be advertised.

·        The content of the local Directory of Services, which 111 access when speaking to patients, is influenced locally by the Haringey CCG.

Out of Hours

·        North Central London is currently split with the North section out of hours being provided by Barndoc and the South section being provided by Harmoni.

·        In Haringey provision of out of hours by Harmoni ends on 1^st April and Barndoc takes over as of 2^nd April.

·        Harmoni will continue to provide out of hours in Camden and Islington and Barndoc will cover Barnet, Enfield and Haringey.

·        The 2012 activity statistics showed that 10,212 residents contacted out of hours services.  Of these

1.    8,366 patients had a face to face appointment at a site.

2.    The remaining received advice on the phone or where referred to other providers the next day e.g. pharmacist or GP.

3.    N.b These figures do not include home visits which are counted separately.  These will be provided for the Panel.

4.    Of the 8,366 the following shows which bases Haringey residents visited:

·        5,306 at the Laurels

·        2,527 at the Whittington

·        259 at St Pancras

·        274 at Homerton (Harmoni’s Hackney base).

·        The Barndoc Service Specification is the same as it was before for Harmoni – there is no service change and home visits will continue.

·        However, the face to face sites will change – the Laurels will continue to be the Haringey base, Finchley, Edgware and Chase Farm will be additional bases.  The Whittington will no longer be an option for out of hours.  However it was noted that the Urgent Care Centre would still be an option for patients wishing to go to the Whittington.

1.    At present out of hours services are available until 11.30pm at the Whittington and the Urgent Care Centre is open until 10.30pm.

2.    The Whittington was the Islington base for Harmoni.

·        Islington are currently consulting on whether there is a need for out of hours services next door to an urgent care centre when both centres could be seeing the same kind of patient.

·        There is extensive communication work currently taking place on changes to health services and there is a recognition that there is a need to be very clear about the changes.

·        There is a national campaign going on and Haringey are also working on a local campaign.

Barndoc introduction

·        Barndoc formally introduced themselves to the Panel.

·        Barndoc has been introducing themselves to GPs around the borough and has also invited any interested Haringey GPs to contact them should they wish to do some Out of Hours shifts.

Discussion points noted:

·        The Panel queried why there are two different organisations providing services which could be provided by one.  The Panel was informed that if you call 111 then you can be transferred to out of hours services.

·        A local Patient Participation Group Chair questioned what the process would be when compared with the current NHS Direct, for example when someone called who had accidently taken an extra tablet of their medication.  The PPG Chair was informed that the process in this case would be exactly the same and that the clinical adviser would take over the call from the call handler.

·        The online presence of the NHS in NHS Direct will continue and will be essentially the same.

·        Urgent Care Centres are still available and are growing.

·        There is a Pan London Clinical Governance group which scrutinises data across London.

·        Barndoc data has been benchmarked with Hillingdon and Croydon.

·        The Panel raised concerns about the change to the access location of out of hours services for some residents in the borough, particularly those who live near or are use to using the Whittington  It was noted that there are approximately 7 patients per day which use the Whittington in this manner.

·        The Panel asked for clarity on what impact the new provider would have on existing mechanisms and services and was informed that when you call out of hours the call handler will look at services in the local directory which are closest to the GP surgery you are registered with.  If you are not registered with a GP this will be based on your postcode.

·        If a caller states they are not happy with the choice that they have been given then the call handler pulls up a secondary set of services.

·        At 11pm all calls to out of hours are moved to home visits.

·        The Panel questioned whether all GPs who provide out of hours services would be proficient in English and was informed that all GPs must pass an English test before the are registered with the General Medical Council and that they must pass an additional test before they are put on the Local Medical Council register.

·        The Panel queried the languages that are covered by call staff given the diversity of Haringey and was informed that Barndoc staff speak 20 languages.  The Panel also noted that Language Line translation services is used when needed, in the last quarter this service was used for 13 languages.

·        The Panel questioned how Barndoc intends to work with HealthWatch and was informed that they have a Patient Forum which currently includes a LINk members.  There is also a contractual requirement to get feedback by three  mechanisms:

1.    External Mori Survey

2.    Barndoc survey

3.    Pain Management Survey

·        The Local Pharmaceutical Committee representative queried whether Barndoc has access to GP records and was informed that they do not.  However, they will build up their own database based on the calls they receive and any information provided by GP surgeries (with patients permission).

·        Barndoc representatives assured the Panel that there was a rigorous interview process in place and that every GP performing out of hours services needed to do a minimum amount of sessions per month, and that there were training requirements to ensure that out of hours services are kept to a high standard of care.

Agreed

·        The Panel would revisit 111 and Out of Hours in approximately 6 months, when performance data would be available for 2 quarters which the Panel could consider.

·        Jill Shattock would provide data on home visits undertaken by out of hours services.

·        Due to the Panel’s concerns about the change in Out of Hours services available to Haringey residents at the Whittington Hospital the Panel agreed to follow this up outside of the meeting and by requesting further clarification and information.