NHS 111 and Out of Hours joined up in new 24-7 urgent clinical service

NHS 111 and general practice Out of Hours services have been brought together under a new 24/7 urgent clinical service set to offer advice and treatment to patients.

The service is expected to provide a “new front door” to urgent healthcare services by streamlining the way these services are delivered nationwide as part of NHS England’s ongoing Urgent and Emergency Care Review.

Commissioners are now being recommended to establish ‘urgent care clinical hubs’ to provide clinical advice and support to patients and professionals working in out-of-hospital settings.

Some of the clinicians and other healthcare professionals that comprise these hubs may be physically located in the integrated urgent care call centre and provide an all-day presence, but they will usually be providing advice remotely, from their normal place of work.

As part of the move, NHS England has published new commissioning standards guidance today (16 October) to ensure commissioners know how to bring together call handling and assessment, clinical advice and treatment under a single commissioning framework.

Prof Keith Willet, NHS England’s director for acute care, who is heading the review, said: “A fundamental redesign of the NHS urgent care ‘front door’ is much needed and now underway. This includes A&E, GPs, 999, 111, Out of Hours, community and social care services.

“Most patients access urgent healthcare through their own GP practice in the daytime and we expect this will remain the first point of contact in the future. But around the clock, the ‘111’ number will find you GP and other urgent healthcare advice – so it makes sense to align the GP out of hours calls behind the same ‘111’ number.”

The redesigned service hopes to direct people to those who can best help them locally, as well as massively alleviate demand pressures on hospital A&E teams, 999 ambulance paramedics and GPs.

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Dr Ossie Rawstorne, medical advisor to NHS 111, said the telephone service helps shift the burden away from these overstretched services, but the separate working arrangements of NHS 111 and Out of Hours services have been confusing to some patients.

“This will ensure they are working more closely together and providing a better response to patients in need of help,” he continued.

Today’s guidance was published following widespread engagement with external stakeholders, including the Royal College of General Practitioners and the BMA.

The standards are also part of plans by NHS England and Health Education England to bolster the NHS 111 workforce, particularly after it was revealed that the service suffered from extremely worrying understaffing levels.

The development programme aims to support the changing needs of the existing and future ‘111’ workforce by bringing together commissioners, providers and local education groups to develop new training based on best practice.

David Davis, paramedic and NHS England’s clinical lead for the programme, said the value and potential of the phone service and integrated urgent care is huge – and one which requires a fully developed, highly-trained and skilled workforce to ensure it is delivered safely.

“Talking to frontline workers, providers and commissioners of NHS 111, we know there are areas which work extremely well and others that have challenges, such as the staff recruitment and staff retention,” he said.

“We know we need to ensure that we invest in developing a skilled and valued workforce for the future.”

The integration of the two services was first announced in June after Dr Caron Morton, co-chair of the Urgent and Emergency Care National Steering Group, gave a presentation on it at the Commissioning Show outlining what to expect from the review between now and 2017.

(Top image c. London Ambulance)


Kadiyali Srivatsa   17/10/2015 at 20:25

I simply cannot understand why NHS is bent on saving this NHS Direct or the 111 service. This triage system was built on unstable foundation. I have worked in NHS direct and understood the problem well and so created Medical Advice You Access. This tool acts like a junior doctor and so safe. The symptoms listed are common. I am sure the App I created will bring in changes that will help patients and doctors. It's sad the politicians are still wasting money and depriving people the care they deserve

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