To receive a presentation from Jill Shattock, Director of Commissioning, Haringey Clinical Commissioning Group, and Dr Sam Shah, Clinical Lead – NHS 111 Governance, concerning plans to commission an integrated 111 and Out-of-Hours service to start in April 2016.
Minutes:
The Chair informed the panel that a request to speak had been received concerning plans to commission an integrated 111 and GP Out-of-Hours service.
Dr Natasha Posner, on behalf of the Defend Haringey Services Coalition and 38 Degrees, addressed the panel and raised a number of points, including:
- Concerns that Clinical Commissioning Groups in Camden, Islington, Haringey, Barnet and Enfield were about to embark on a tendering exercise for a combined 111 and GP Out-of-Hours service across the five boroughs.
- The need to have local services with local GPs
- Concerns that the new service could be provided by a private company.
- The need for a pilot study to ensure the amalgamation of 111 with Out-of-Hours across five boroughs improved services.
- The need for better consultation and engagement with the public.
- Concerns about the proposed length of the contract
The panel then received a presentation from Jill Shattock, Director of Commissioning, Haringey Clinical Commissioning Group (CCG), and Dr Sam Shah, Clinical Lead – NHS 111 Governance.
The panel was informed that Haringey CCG had been working with other CCGs in North Central London to integrate the NHS 111 service and the GP Out-of-Hours service to enable both services to work better together.
It was noted that 111 was a free telephone number that helped people with urgent, but not life-threatening, conditions to access the most appropriate service or to receive self-care advice. Ms Shattock advised the panel that between April 2013 and March 2014 an estimated 33,000 calls had been made to 111 from people living in Haringey.
The panel was informed that GP Out-of-Hours services ensured people could access primary care, for urgent problems, when their GP surgery was closed. It was noted that Barndoc provided the service in Barnet, Enfield and Haringey and that GP Out-of Hours services were accessed via NHS 111.
The following points were discussed:
- GP co-operatives
- Telephone triage services
- The patient journey before 111
- The 111 patient journey
Dr Shah informed the panel that 111 had been introduced, as a pilot, in 2013 and had replaced NHS Direct. The panel was assured that a number of lessons had been learned, including:
- Combining 111 and GP Out-of-Hours services under a single contact had helped patients to get the right services quicker, with less time spent being passed from one call handler to another.
- Early input from a nurse, GP or pharmacist helped patients get the right advice/treatment more quickly.
- 111 could make better use of local community services
- The need for 111 to develop better online/app interfaces
- The majority of users of the 111 service were between 18 and 64 years old.
In terms of the proposal to commission an integrated 111 and GP Out-of-Hours service, Dr Shah advised that there would be an increased clinical mix in 111. This would include:
- The introduction of GP early intervention in 111 calls and rapid clinical reassessment of green ambulance dispositions.
- GP consultation within Out-of-Hours for the overnight period.
- A pharmacist within 111.
- Better information systems to enable more integrated working.
Dr Shah informed the panel that the model for NHS 111 and GP Out-of-Hours across North Central London would be fully integrated with local health care services. This would enable: direct appointment bookings into other services, including home visits; better information sharing and access to patients’ medical histories (for those involved directly in patient care); the immediate dispatch of an ambulance, if needed; and easy access to out of hours GP services, if needed.
The following issues were discussed:
- There was no evidence to suggest increased attendance at A&Es was a result of unnecessary referrals from the 111 service.
- About 47% of onward referrals from NHS 111 in North Central London were to GP Out-of-Hours. It was noted that this provided a strong case for integration.
- Data provided by the Commissioning Support Unit showing 111 caller locations by registered patients. It was noted there were no geographical ‘clusters’ for users of the 111 service since people did not necessarily call from home, but could access the service anywhere across the five boroughs. Any new model would therefore need to cover the whole North Central London area.
- The integration of IT systems for both services
- The procurement process and the specification. Dr Shah informed the panel that while price was a factor it was essential to ensure the correct balance between this and quality. It was noted that local clinicians had been very involved in developing the service specification for the procurement.
- The importance of contract monitoring and holding service providers to account.
Jill Shattock commented that all CCGs were in the process of developing local engagement plans and Haringey CCG had started a process of involving stakeholders and members of the public and would continue to do so.
The panel was informed that Haringey CCG would welcome the opportunity to meet with Defend Haringey Services Coalition, 38 Degrees, and other local groups, as part of this work.
The following milestones were noted:
- Public engagement: February – June 2015
- Establishing a reference group to inform the procurement process (with local Healthwatch organisations and patient representatives) – March 2015.
- Procurement process: April 2015 – March 2016
- New service to start April 2016
The panel thanked Jill Shattock and Dr Shah for their attendance and encouraged Haringey CCG to fully engage with local groups to help improve 111 and Out-of-Hours GP services for Haringey.
RESOLVED: That the presentation by Jill Shattock, Director of Commissioning, Haringey Clinical Commissioning Group (CCG), and Dr Sam Shah, Clinical Lead – NHS 111 Governance, be noted.