service is a singular point of access for the public to use when needing health care and advice • It is designed to facilitate calls which are less urgent than 999 (however still incorporates 999 process when required) • It is a national program designed to meet the local requirements of an area
4 I take down the contact details and demographics of the patient . With the help of my NHS SMART card I have quick access to existing patient contact / demographic information, which speeds up the initial exchange and gets me straight into patient triage.
1-1-1 • The Health Advisor takes down demographic information using the Adastra system and pulls patient details off the NHS SPINE using their smart card • If the patient is symptomatic the Health Advisor will triage the call using NHS Pathways • If the patient is asymptomatic such as a request for health information, the Health Advisor has various services via Adastra and using the DOS (Directory of Services) to refer or advise the patient Page 5
“ruling out” technique, which is risk averse and will arrive at a disposition to manage the assessed risk • A disposition is determined based on appropriate time frame and identified health needs: • “Consult your GP practice within 6 hours” or • “Attend / go to an A&E within 1 hour” • After the disposition is reached the DOS is launched which lists in ranking order all the services which match the required skill set and are geographically appropriate for the patient Page 6
8 From the information you have given me you need to contact your GP practice with the view of getting a possible appointment within the next 6 hours. As it is currently out of practice hours, I can arrange for a base visit for you to see a practitioner from your local out of hours service.
disposition is given a code which is linked to all the relevant services on the DOS • This allows for several appropriate services to be displayed on screen which the Health Advisor can use to direct the patient to • If the call is complex, beyond the scope of the Health Advisor or the patient refuses the NHS Pathways disposition instruction, the Health Advisor can warm transfer this call to an in-house clinician (Paramedic or Nurse) Page 9
Health Advisors - Immediate life-threats identified via smaller database of age and gender Pathways - Basic, but vital information collected e.g. illness or injury GP urgent/hospital transfers handled here - Some care advice available Module 1 - Used by Health Advisors - Large database of age & gender specific Pathways - Extensive care advice available Module 2 - Used by NHS Pathways trained clinicians - Smaller database of Pathways - Pick up where the corresponding Module 1 Pathways ended - Extensive care advice available Page 11
(HA) and Clinical Advisor (CA) Call Audits: • HA and CA are audited at least 4 times every three months throughout their NHS 111 service • The audit is a standardised audit tool which looks at 8 key competencies which are required for both a Health Advisor and a Clinical Advisor • These competencies include various technical, interpersonal and operational skills, including a heavily weighted scoring for Clinical Safety Page 14
a NHS 111 Health Advisor Page 15 The Pathways Call Audit Tool Call Handler Full or NA Partial Not achieved Date: Call ID: Staff member name: Auditor: Any other relevant information: Compete ncy Indicators Comments- give specific examples to aid constructive & specific feedback Effective call control 1 Makes efforts to speak directly to patient 2 1 0 2 Greets caller appropriately 2 1 0 3 Explains process to caller effectively 2 1 0 4 Controls flow of information from caller 2 1 0 5 Paces call according to clinical urgency, caller's needs & service demands 2 1 0 6 Maintains call flow by effective multi-tasking 2 1 0 Skilled questioni ng 1 Accurately conveys the clinical meaning of questions 2 1 0 2 Recognises when to probe 2 1 0 3 Phrases questions in a way that callers can understand 2 1 0 4 Avoids overly leading questions 2 1 0 5 Ensures every question is answered adequately 2 1 0 Active listening 1 Picks up accurately on verbal cues/non-verbal cues/relevant background noise 2 1 0 2 Recalls information given 2 1 0 3 Demonstrates active listening to caller 2 1 0
formalised CQI report is generated by Connecting for Health and given to each NHS 111 service provider • This report can be used to highlight individual outliers who are either under or over performing. This allows for focused call audits to verify performance and manage clinical safety Page 16
show the following: • Individual average call handling times • % of calls an individual Health Advisor transfers to ambulance • % of calls an individual Health Advisor transfers to an in-house clinician • % of calls an individual Health Advisor transfers to various services • Where in NHS Pathways the Health Advisor transfers There are a number of other fields which can be used to analyse Health Advisor performance. Page 17
from both the CQI report and individual call audits, drives performance management of Health Advisors and Clinical Advisors within the NHS 111 service • A coaching ratio of 1 coach for every 12 Health Advisors , and 1 coach for every 6 Clinical Advisors allows for constant in-service support • Managers and supervisors use call audit results and CQI reports to plan what interventions can be put in place to improve individual performance Page 18
Advisors and Clinical Advisors need to maintain an average of 200 calls per month over a year period in order to maintain their NHS Pathways call handler license • The service also looks at identifying other areas of development and up skilling, such as the case in equipping advisors with vital requirements such as safeguarding skills Page 19
groups, and regular formalised feedback channels for GPs and other health service providers are also used as input into our NHS 111 service review • This has specific focus on the patient journey and elicits response from all stakeholders - (the patient, health care practitioners, service providers, commissioning officials, and patient review / focus groups) Page 20
• Issues with various individual Pathways, the DOS and NHS Pathways systems have formalised feedback and reporting channels • This means constant improvement to the NHS Pathways tool, and improvement to the NHS 111 service Page 21
Audits, and Patient, Stakeholder feedback allow for focused review of our overall operational delivery of the service, both on an individual level and on the service as a whole • This allows for improved training, coaching, processes and procedures, and the development of improved IT and Telephony systems and reporting / service management tools Page 22
and Key Stakeholders Page 23 Please choose date: 111 Area : SW (All Contracts) 1.0 telephony system total number of calls Offered to the NHS111 provider ACD (OOH & 111) over the 24hour period 1.1 Total number of abandoned calls 30 seconds after the message (NQR8 <5%) MDS Abandoned calls as a percentage of total calls offered (target <5%) abandoned calls as a % of offered - calls abandoned before 30 seconds 1.2 Total number of calls answered over the 24hour period This is taken from the telephony system and counts all the calls that were answered from the OOH and 111 Calls offered number of calls answered as a percentage of Offered 1.3 Of the calls answered how many calls were answered within 60 seconds (NQR8, target 95%) Percentage answered calls within 60 seconds Based on calls answered of all the calls answered in section 1.2, these calls were answered within 60 seconds of the message finishing 1.4 Total number of phantom calls received over a 24 hour period This is the number of calls where, when answered, there is nothing or no one at the end of the phone and would be classed as non triaged Based on calls answered 1.5 Total number of calls answered not requiring 111 This is the number of calls where the caller did not require 111 and would be classed as non triaged. Call logs should be completed by staff member on host system as per operational process Based on calls answered 1.6 Total number of remaining calls answered not requiring triage This is the number of calls where the caller did not require 111 and would be classed as non triaged. Based on calls answered 1.7 Total number of calls triaged over a 24 hour period This is the number of cases that has launched NHS Pathways assessment (final DX code count) Based on calls answered 1.8 Average episode length of call (mins) (hh:mm:ss) Case entry to finish case The episode length is taken from the moment that the host system case is created to when the case is closed following completion of the call. This includes any wait time or transfer time, the non clinical and clinical time plus any onward referral time through dos. The top 2.5% and bottom 2.5% should be removed. 1.9 Average length of call (mins) with the non clinical Call handler (hh:mm:ss) This is taken from the telephony and is the talktime, patient related not ready time and wrap time 2 Average length of call (mins) with the clinical 111 advisor (hh:mm:ss) This is taken from the telephony and is the talktime, patient related not ready time and wrap time 2.1 Total number of calls directed for ambulance dispatch Ambulance dispatch as a percentage of total Based on calls answered This is the number of calls with an ambulance disposition code as defined by DH MDS definitions list based on calls triaged 2.2 Total number of Non conveyed 999 dispatches No data available Of the incidents in 2.1, these calls were not conveyed to hospital as a % of 999 dispositions Based on SWAST data Daily Sitrep (Period should run from 00:00.00 to 23:59.59) Daily Reporting NHS 111 Sitrep Reporting Data Collection Template DHV0.4 Provider :
collected by the singular point of access (NHS 111 service) allows for valuable information on service utilisation and specific skill set demands at the local level • This is a valuable tool which can be used when commissioning services in the NHS Page 24
treating our patients as family • We want our patients to have not just the expected high levels of good service but to also have a truly positive and impactful experience during their patient journey while phoning 1-1-1 • Our focus is not only on improving service delivery and maintaining patient safety but also on developing a culture of empathy and compassion for all who call in on our NHS 111 service Page 25
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