DOCSLIB.ORG

Impact of the Urgent Care Telephone Service NHS 111 Pilot Sites: a Controlled Before and After Study

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Impact of the Urgent Care Telephone Service NHS 111 Pilot Sites: a Controlled Before and After Study BMJ Open: first published as 10.1136/bmjopen-2013-003451 on 13 November 2013. Downloaded from Open Access Research Impact of the urgent care telephone service NHS 111 pilot sites: a controlled before and after study J Turner, A O’Cathain, E Knowles, J Nicholl To cite: Turner J, ABSTRACT ’ et al ARTICLE SUMMARY O Cathain A, Knowles E, . Objectives: To measure the impact of the urgent care Impact of the urgent care telephone service NHS 111 on the emergency and telephone service NHS 111 Strengths and limitations of this study urgent care system. pilot sites: a controlled before ▪ This is the first controlled evaluation of the and after study. BMJ Open Design: Controlled before and after study using routine impact of the NHS 111 service on the emergency 2013;3:e003451. data. and urgent care system in England. This is doi:10.1136/bmjopen-2013- Setting: Four pilot sites and three control sites covering timely as the service is being rolled out 003451 a total population of 3.6 million in England, UK. nationally. Participants and data: Routine data on 36 months of ▪ There is limited evidence on the use of non- ▸ Prepublication history and use of emergency ambulance service calls and incidents, clinical call handlers to triage requests for urgent additional material for this emergency department attendances, urgent care contacts care and this study adds to the evidence base. paper is available online. To (general practice (GP) out of hours, walk in and urgent ▪ Although we conducted a controlled study other view these files please visit care centres) and calls to the telephone triage service system changes made it difficult to isolate the the journal online NHS direct. effects of NHS 111 and we were unable to assess (http://dx.doi.org/10.1136/ Intervention: NHS 111, a new 24 h 7 day a week the potential impact on in-hours GP services. bmjopen-2013-003451). telephone service for non-emergency health problems, operated by trained non-clinical call handlers with clinical Received 20 June 2013 responses to people who require or perceive Revised 23 August 2013 support from nurse advisors, using NHS Pathways Accepted 25 September 2013 software to triage calls to different services and home the need for urgent advice, care, treatment ’ 1 care. or diagnosis . Problems faced by users of Main outcomes: Changes in use of emergency and emergency and urgent care included a lack http://bmjopen.bmj.com/ urgent care services. of awareness of services available, confusion Results: NHS 111 triaged 277 163 calls in the first year about which service to access and multiple 2 of operation for a population of 1.8 million. There was no service contacts for the same episode. In change overall in emergency ambulance calls, emergency England in 2000 a national 24 h telephone department attendances or urgent care use. There was a line for advice about health problems, 19.3% reduction in calls to NHS Direct (95% CI −24.6% National Health Service (NHS) Direct, was to −14.0%) and a 2.9% increase in emergency established to address similar frustrations. ambulance incidents (95% CI 1.0% to 4.8%). There was Calls are answered by a non-clinical call an increase in activity overall in the emergency and handler and assessed by a nurse either imme- on September 26, 2021 by guest. Protected copyright. urgent care system in each site ranging 4.7–12%/month diately or with a later call back. Despite this and this remained when assuming that NHS 111 will service the national consultation found that eventually take all NHS Direct and GP out of hours calls. 1 Conclusions: In its first year of operation in four pilot access problems persisted. sites NHS 111 did not deliver the expected system NHS 111 was developed as a solution to benefits of reducing calls to the 999 ambulance service these problems by offering a telephone or shifting patients to urgent rather than emergency care. service to manage all requests for urgent There is potential that this type of service increases help3 including requests for out-of-hours overall demand for urgent care. primary care, urgent problems that may cur- rently be directed to 999 ambulance services and health information and advice. The key differences from NHS Direct are—access Medical Care Research Unit, through a free-to-call, easily remembered ScHARR, University of INTRODUCTION three digit telephone number ‘111’; calls Sheffield, Sheffield, UK A consultation by policy makers in England answered and assessed immediately by a fi Correspondence to identi ed that a key frustration in the trained non-clinical call handler without Ms J Turner; general population was access to urgent waiting or call backs; only some calls assessed [email protected] care.1 Urgent care is defined as ‘the range of by a nurse; and integration of the assessment Turner J, O’Cathain A, Knowles E, et al. BMJ Open 2013;3:e003451. doi:10.1136/bmjopen-2013-003451 1 BMJ Open: first published as 10.1136/bmjopen-2013-003451 on 13 November 2013. Downloaded from Open Access system with services enabling direct referral to, or community services or home care. Referrals can be appointments to be made with, some services at the made to some services by NHS 111 at the time of the time of the call. call, for example, direct dispatch of an emergency ambu- The expected benefits of NHS 111 were to improve lance, appointment booking and transfer of the call to access to urgent care, increase efficiency by directing another telephone-based service. A description of the people to the ‘right place first time’ including self-care NHS 111 service is provided as a online supplementary advice, increase satisfaction with urgent care and the file (S1). NHS generally, and in the longer term reduce unneces- sary calls to the 999 emergency ambulance service and Design so begin to rectify concerns about the inappropriate use The design of this part of the evaluation was a descrip- of emergency services.4 tive study of NHS 111 service use and a controlled NHS 111 was established in four pilot sites in England before and after study using a time series analysis of in 2010. It is rapidly becoming available nationally and routine service activity data. Control sites were selected there is international interest in telephone access to to match equivalent geographical areas to the pilot sites urgent care through non-clinical triage. A mixed using a two stage process: (1) potential sites were identi- methods evaluation focusing on processes, outcomes fied by primary care trust area type (county or city), and costs was conducted in the four pilot sites. We urban/rural mix and same Strategic Health Authority report here on the specific outcome of NHS 111 improv- (SHA) or nearest neighbour; (2) from 12 potential sites ing efficiency of service use across the emergency and the final choice was made after matching for a range of urgent care system by shifting care from emergency to 18 criteria based on population demographics, lifestyle, urgent services. The objective was to assess the impact of health profile and health service use. A table listing all NHS 111 on the emergency and urgent care system by criteria is provided as a online supplementary file (S2). examining demand for other urgent and emergency It was important that control sites had no plans to intro- care services to detect if there was any change in how duce NHS 111 or make major changes to their emer- services were used. gency and urgent care system in the time frame of the evaluation. We identified three suitable control sites: North of Tyne, Leicester and Norfolk. Leicester was the METHODS best match for two pilot sites (Nottingham and Luton). Setting and service The control site for Luton is not in the same SHA but Pilot services were established in four geographical areas was the best match for all other criteria and was the only defined by primary care trusts, the healthcare commis- suitable nearest neighbour SHA. For the main impact sioning organisations operating in England in 2010. analysis sites have been combined to provide single pilot Durham and Darlington is an urban area with a popula- and control sites. The characteristics of the pilot and http://bmjopen.bmj.com/ tion of around 606 000; Nottingham is a city of around control sites are presented in table 1. For the analyses 300 000 with a large minority ethnic population; Luton reported here data from all pilot sites were combined is a city of around 200 000 with a large minority ethnic and compared with data from all control sites. population; and Lincolnshire is a largely rural area with Randomisation of sites to be pilots or controls was not a city, of population 700 000. The four sites were chosen possible because the four pilot sites were preselected by by the English Department of Health following a the Department of Health. request for expressions of interest from commissioning The four pilot sites became fully operational at differ- organisations already planning or considering changing ent times from July to December 2010. The study on September 26, 2021 by guest. Protected copyright. telephone access to urgent care. Call handling was pro- periods used were the first full year of operation of NHS vided by an ambulance service in one site and NHS 111 and the corresponding 2 years prior to the service Direct in three sites. In all sites NHS 111 could be starting. During the course of the evaluation NHS Direct accessed directly by dialling ‘111’ or indirectly where continued to operate as a national service within the general practice (GP) out-of-hours call-handling services pilot site areas.
Load more

Recommended publications
  • NHS111 Online Evaluation
    OFFICIAL-SENSITIVE NHS111 Online Evaluation December 2017 1 OFFICIAL-SENSITIVE Choose an item. NHS111 Online Evaluation Produced by NHS England Version number: Final First published: December 2017 Classification: OFFICIAL-SENSITIVE The National Health Service Commissioning Board was established on 1 October 2012 as an executive non-departmental public body. Since 1 April 2013, the National Health Service Commissioning Board has used the name NHS England for operational purposes. Acknowledgements: Data team at NHS Digital Nikki Patel, Head of Evaluation and Research, NHS England Provider sites Suppliers Health Innovation Network AHSNs YAHSN 2 OFFICIAL-SENSITIVE Choose an item. Contents Contents ..................................................................................................................... 3 1 Purpose ............................................................................................................... 5 2 Approach ............................................................................................................. 5 3 Key Findings ....................................................................................................... 5 4 Conclusion .......................................................................................................... 6 5 Context ................................................................................................................ 7 6 Background ........................................................................................................ 8 2012:
    [Show full text]
  • Coronavirus (COVID-19) Guidance
    Coronavirus (COVID-19) Guidance PIDGIN Dis advice get im base for di health advice and information of NHS dem, and e bi advice for everyone wey dey for UK, no mata which country dem come from. Version 8 [15.12.2020] Translated by Contents Wetin bi Coronavirus (COVID-19) and how persin go fit stay safe? Wetin you fit do if una get symptoms? Guidance on how to stay separate for pipo wey dey live for di same house and wey fit don catch coronavirus (COVID-19) infection How long persin go follow di guidance on how to stay separate? When you go contact NHS 111? How you go contact NHS 111? Wetin you go do if you dey worried about your immigration situation? Wetin you go do to helep stop Coronavirus (COVID-19) say make im no spread? Wetin bi Coronavirus (COVID-19) and how persin go fit stay safe? COVID-19 na new illness wey fit affect una lungs, airways and other organs dem. Na one virus wey dem dey call coronavirus dey cause am. You fit stay safe if you reduce how una dey get near pipo dem wey no dey live for di same domot with una, and by following important rules wey consain hygiene as much as possible to helep stop di spread of coronavirus. Dis includes pipo for all ages dem – even if you no show any sign or get any kain serious sickness so. To dey use public transport: Make you try avoid to dey use public transport as much as possible and try to dey cycle, walk or drive instead.
    [Show full text]
  • Impact of the Urgent Care Telephone Service NHS 111 Pilot Sites: a Controlled Before and After Study
    Open Access Research Impact of the urgent care telephone service NHS 111 pilot sites: a controlled before and after study J Turner, A O’Cathain, E Knowles, J Nicholl To cite: Turner J, ABSTRACT ’ et al ARTICLE SUMMARY O Cathain A, Knowles E, . Objectives: To measure the impact of the urgent care Impact of the urgent care telephone service NHS 111 on the emergency and telephone service NHS 111 Strengths and limitations of this study urgent care system. pilot sites: a controlled before ▪ This is the first controlled evaluation of the and after study. BMJ Open Design: Controlled before and after study using routine impact of the NHS 111 service on the emergency 2013;3:e003451. data. and urgent care system in England. This is doi:10.1136/bmjopen-2013- Setting: Four pilot sites and three control sites covering timely as the service is being rolled out 003451 a total population of 3.6 million in England, UK. nationally. Participants and data: Routine data on 36 months of ▪ There is limited evidence on the use of non- ▸ Prepublication history and use of emergency ambulance service calls and incidents, clinical call handlers to triage requests for urgent additional material for this emergency department attendances, urgent care contacts care and this study adds to the evidence base. paper is available online. To (general practice (GP) out of hours, walk in and urgent ▪ Although we conducted a controlled study other view these files please visit care centres) and calls to the telephone triage service system changes made it difficult to isolate the the journal online NHS direct.
    [Show full text]
  • The Impact of Covid-19 on the Use of Digital Technology in the NHS
    Briefing August 2020 The impact of Covid-19 on the use of digital technology in the NHS Rachel Hutchings Key points • The Covid-19 pandemic has resulted in the rapid adoption of digital technology in the NHS and significant changes in the delivery of services more widely – to free up space and capacity in acute hospitals, enable remote working and reduce the risk of infection transmission in NHS settings. Primary care in particular has seen a huge increase in remote appointments. • There has also been a surge in patients’ uptake of remote health services, including registrations for the NHS App, NHS login and e-prescription services. • These changes have happened at an incredible pace. Central bodies have taken steps to enable the changes to occur, providing guidance on information governance and fast-track procurement frameworks, for example. Meanwhile, health care professionals have had to respond innovatively to continue to provide services to patients. • But despite the undeniable progress that has been made, it is important to proceed with caution. Especially when changes happen at such a pace, there are possible risks and downsides. • It is essential that we understand – through robust evaluation and research – what the impact of the rapid shift towards digital technology has been on clinical practice, patients’ access to and quality of care, and the experiences of patients and staff. Studies in these areas remain limited, so more work is needed to learn from the experience and determine whether we need to revisit existing priorities. • To embed the positive work that has been done during the pandemic and ensure that it is sustainable in the future, it needs to be underpinned by adequate funding, infrastructure and the necessary workforce.
    [Show full text]
  • Medical Staffing in England: a Defining Moment for Doctors and Patients
    Medical staffing in England: a defining moment for doctors and patients British Medical Association bma.org.uk British Medical Association Medical staffing in England: a defining moment for doctors and patients 1 Contents Acknowledgements ...........................................................................................................................................2 Table of Figures .....................................................................................................................................................3 Foreword ...................................................................................................................................................................4 Statement from the BMA Patient Liaison Group................................................................................6 Executive Summary ...........................................................................................................................................7 Introduction............................................................................................................................................................9 Context ...................................................................................................................................................................11 Chapter 1 – Medical workforce growth in England is 25 years behind comparator nations .......15 The current estimated medical workforce deficit is alarming .......................................................16
    [Show full text]
  • Annual Report & Accounts 2018-19
    Annual Report & Accounts 2018/19 Our vision Building a world-class ambulance service for a world-class city London’s primary integrator of access to urgent and emergency care on scene • on phone • online Our purpose We exist to: Provide outstanding care for all of our patients Be a first class employer, valuing and developing the skills, diversity and quality of life of our people Provide the best possible value for the tax paying public, who pay for what we do Partner with the wider NHS and public sector to optimise healthcare and emergency services provision across London Our values & behaviours Respectful Professional Innovative Collaborative Caring for our patients Acting with honesty Thinking creatively Listening and and each other with and integrity learning from Driving value and compassion and each other Aspiring to clinical, sustainable change empathy technical and Working with partners Harnessing technology Championing equality managerial excellence and new ways of Being open and and diversity Leading by example working transparent Acting fairly Being accountable and Taking courageous Building trust outcomes orientated decisions Annual Report & Accounts 2018/19 Section one – Performance Report Contents Performance Report Section one 1. Chair’s Foreword 2 2. Chief Executive’s Foreword 3 3. About Us 4 4. Our Patients 10 5. Our People 18 6. Our Partners 32 7. Our Public Value 36 8. Quality and Performance 38 9. Our Five-Year Strategy 46 Accountability Report Section two 10. Annual governance statement 49 11. Remuneration report 62 12. Staff report 69 Financial Report Section three 13. Financial Statements 71 14. Appendix – Glossary of Terms 121 London Ambulance Service NHS Trust Performance Report – Section one Annual Report & Accounts 2018/19 the rest of the health sector as well as our colleagues in the Metropolitan Police Service and London Fire Brigade.
    [Show full text]
  • Self Care: Question & Answer
    Self care: question & answer Introduction Link to contents Self care encompasses the things individuals can do – What is self care? to protect their health and manage illness. The social – Are there different types of determinants of health – the conditions in which people self care? are born, grow, live, work and age – influence our resistance to illness and disease, as well as our ability to – What are the benefits of self care? self care. There is a risk that without easily accessibly – What are the risks of self care? support and advice the advantages of self care will only be felt by higher socioeconomic groups. To help improve – Does self care work? How do patients’ understanding of self care, the BMA’s (British we know? Medical Association’s) PLG (Patient Liaison Group) – What are my self care options? has developed a ‘question and answer’ resource. The Where can I access them? resource is not intended to be exhaustive: its purpose is to provide patients with a basic introduction to self care, – Are there self care/self help including what it involves, the risks and benefits, and support groups? where it can be accessed. – When should I use self care and when should I see a doctor? – What work has the BMA done Self care does not mean that you on self care? need to manage on your own without any help from a health professional. This resource identifies the different sources of support available. If you are at all unsure, please seek advice from your GP, nurse or pharmacist. British Medical Association bma.org.uk British Medical Association Self care: question and answer 1 What is self care? Self care is about putting people in control of their own health and well being.
    [Show full text]
  • NHS Wales – Review of the 111 Pathfinder in Association with Janette Turner, University of Sheffield Final Report – November 2017
    NHS Wales – Review of the 111 Pathfinder In Association with Janette Turner, University of Sheffield Final Report – November 2017 THE POWER OF BEING UNDERSTOOD AUDIT | TAX | CONSULTING TABLE OF CONTENTS NHS WALES – REVIEW OF THE 111 PATHFINDER ................................................................................. 1 IN ASSOCIATION WITH JANETTE TURNER, UNIVERSITY OF SHEFFIELD .......................................... 1 FINAL REPORT – SEPTEMBER 2017 ........................................................................................................ 1 GLOSSARY OF TERMS .............................................................................................................................. 3 1 EXECUTIVE SUMMARY ................................................................................................................... 5 2 INTRODUCTION AND BACKGROUND ......................................................................................... 12 3 STRATEGIC CONTEXT .................................................................................................................. 20 4 LITERATURE REVIEW ................................................................................................................... 23 5 CONSULTATIONS .......................................................................................................................... 26 6 SURVEY RESULTS ......................................................................................................................... 31 7 ACTIVITY LEVEL ANALYSIS
    [Show full text]
  • Integrated Urgent Care Service Specification
    Integrated Urgent Care Service Specification NHS England INFORMATION READER BOX Directorate Medical Operations and Information Specialised Commissioning Nursing Trans. & Corp. Ops. Strategy & Innovation Finance Publications Gateway Reference: 07092 Document Purpose Policy Document Name Integrated Urgent Care Service Specification Author Integrated Urgent Care Delivery Team Publication Date 25 August 2017 Target Audience CCG Clinical Leaders, CCG Accountable Officers Additional Circulation NHS England Regional Directors, NHS England Directors of List Commissioning Operations Description 0 Cross Reference Integrated Urent Care Comissioning Standards Superseded Docs 0 (if applicable) Action Required 0 Timing / Deadlines By 00 January 1900 (if applicable) Contact Details for Integrated Urgent Care Delivery Team further information 4N04 Quarry House Leeds LS2 7UE 0113 824 9506 [email protected] 0 Document Status This is a controlled document. Whilst this document may be printed, the electronic version posted on the intranet is the controlled copy. Any printed copies of this document are not controlled. As a controlled document, this document should not be saved onto local or network drives but should always be accessed from the intranet. Document number: 1 Issue/approval date: 25/08/2017 Version number: V_0.23a Status: approved Next review date: dd/mm/yyyy Page 2 Integrated Urgent Care Service Specification Version number: V_0.23a First published: Prepared by: Integrated urgent care delivery team This information can be made available in alternative formats, such as easy read or large print, and may be available in alternative languages, upon request. Please contact 0300 311 22 33 or email [email protected] stating that this document is owned by the Integrated Urgent Care Delivery Team, Operations and Information Directorate.
    [Show full text]
  • NHS 111 Public Sector Equality Duty (PSED) Analysis of Impact on Equality (AIE)
    NHS 111 Public Sector Equality Duty (PSED) Analysis of Impact on Equality (AIE) October 2012 CONTENTS 1 Executive Summary 2-3 2 Public Sector Equality Duty (PSED) 4-5 3 NHS 111 Overview 6-7 4 NHS 111 Background 8-11 5 Summary of Analysis and Overall Impact 12-18 • Age 18-21 • Disability 21-26 • Race 26-28 • Religion or Belief 28-29 • Sex 29-30 • Sexual Orientation 30 • Gender Reassignment 30-31 • Pregnancy and Maternity 31-32 • Carers 32-33 • Other identified groups 33-35 6 Addressing the Impact on Equalities and Action 36-37 Planning for Improvement Appendix A: NHS 111 Initial Screening Assessment Equality Impact Assessment For the record Name of person who carried out this assessment: Ayan Absia Date assessment completed: 24/10/2012 Name of responsible SCS1/Director/Director General: Nick Hall Date assessment was signed: 31/10/2012 1 Executive Summary This analysis will contribute to the NHS 111 programme’s fulfilment of the Public Sector Equality Duty (PSED). This report considers the impact of the transition from NHS Direct’s 0845 telephone service to NHS 111, mitigation methods to address any disproportionate impact and opportunities to maximise evidence based ‘positive action’1. The evidence used is both qualitative and quantitative, including research papers, evaluation reports, patient and public surveys, health outcomes data, and stakeholder feedback. The Department, NHS and NHS Direct have undertaken a number of exercises over the last few years, which, taken together, go a good way to demonstrate the programme’s commitment
    [Show full text]
  • BMA Policy Book 2019-2020
    BMA policy book 2019-2020 British Medical Association BMA House, Tavistock Square, London, WC1H 9JP Contents ABORTION ................................................................................................................................. 1 ACQUIRED IMMUNE DEFICIENCY SYNDROME (AIDS) .................................................................. 3 ADVERTISING ............................................................................................................................ 4 ALCOHOL ................................................................................................................................... 5 ALTERNATIVE THERAPIES........................................................................................................... 7 ARMED FORCES ......................................................................................................................... 7 PAY .................................................................................................................................................... 10 BMA, STRUCTURE AND FUNCTION ........................................................................................... 11 ARM PROCESS ...................................................................................................................................... 15 COMMUNICATIONS ................................................................................................................................ 17 CONSTITUTION AND GOVERNANCE OF THE ASSOCIATION ..............................................................................
    [Show full text]
  • Coronavirus (COVID-19) Guidance
    Coronavirus (COVID-19) Guidance ENGLISH This advice is based on NHS health advice and information and it is an advice for everyone in the UK, regardless of country of origin. Version 8 [15.12.2020] Contents What is Coronavirus (COVID-19) and how to stay safe? What to do if you have symptoms? Isolation guidance for households with possible Coronavirus (COVID-19) infection How long to follow the isolation guidance? When to contact NHS 111? How to contact NHS 111? What to do if worried about your immigration situation? What to do to help stop Coronavirus (COVID-19) spreading? What is Coronavirus (COVID-19) and how to stay safe? COVID-19 is a new illness that can affect your lungs, airways and other organs. It's caused by a virus called Coronavirus. You can stay safe by reducing your physical contact with people you do not live with, and by following essential hygiene measures as much as possible to help stop the spread of coronavirus. This includes people of all ages – even if you do not have any symptoms or other health conditions. Using public transport: You should avoid using public transport as much as possible and try to cycle, walk or drive instead. If you need to use public transport, try to avoid peak times and maintain physical distancing. You must wear a face covering in public transport. It is important that you follow this guidance, you could be fined if you do not. Continuing to work: You should continue to work from home if you can. If you need to go to work, you should first check that you and members of your household do not have symptoms.
    [Show full text]