Evaluation of NHS 111 pilot sites Final Report

1 Evaluation of NHS 111 pilot sites Final Report Janette Turner Alicia O Cathain Emma Knowles Jon Nicholl Jon Tosh Fiona Sampson Patricia Coleman Joanne Coster August 2012 Evaluation of NHS 111 pilot sites Final Report Page 2 Contents Page Acknowledgements 5 Glossary of terms 6 Executive summary 7 1. Introduction Policy background to the development of NHS 111 NHS 111 service development NHS 111 service Evaluation 13 13 14 14 2. Evaluation aims and design Aims and objectives Evaluation design Study sites Ethics 15 15 15 18 19 3. Evidence base Introduction Methods and findings Results Discussion 20 20 21 22 30 4.

2 NHS 111 service models and implementation Introduction and methods Core service principles NHS 111 operational framework pilot site service descriptions Implementation activities Early implementation lessons learnt from the four pilot sites 32 32 32 33 35 36 40 5. How NHS 111 was used Introduction Methods Results Discussion 42 42 42 43 56 6. Users views of NHS 111 Introduction Methods Results Discussion 58 58 58 60 79 7. Impact on perceptions of the urgent care system Introduction 80 80 Evaluation of NHS 111 pilot sites Final Report Page 3 Methods Results Discussion 80 82 87 8.

3 Impact of NHS 111 on the emergency and urgent care system Introduction Methods Results Durham & Darlington Nottingham City Luton Lincolnshire Summary of findings for individual sites Consideration of overall demand for system Combined analysis for all pilots dose of NHS 111 in system Discussion 88 88 88 91 92 100 108 116 126 126 131 131 132 9. Preliminary exploration of achievement of right place, first time Introduction Methods Results Discussion 134 134 134 137 142 10. The implementation of NHS 111 within local health economies Introduction Methods Results Discussion 144 144 144 145 156 11.

4 Awareness, use and equity Introduction Methods Results Discussion 159 159 159 159 163 12. Economic Evaluation Introduction Methods Results observational analysis Results implementation analysis Discussion 165 165 165 167 175 179 13. Comparison of models Introduction 182 182 Evaluation of NHS 111 pilot sites Final Report Page 4 Results Discussion 182 185 14. Discussion and conclusions Summary of main findings Has NHS 111 achieved the expected benefits? Wider considerations Strengths and limitations Key messages Future research 186 186 187 189 193 194 195 References 196 Appendices Appendix A - Pathways reported by NHS 111 users (Chapter 6) Appendix B Population survey findings (Chapter 7) Appendix C Expert panel review criteria (Chapter 9) 201 203 209 Evaluation of NHS 111 pilot sites Final Report Page 5 Declarations of interest Professor Alicia O Cathain and Professor Jon Nicholl are co-applicants on an NIHR Applied Research Programme led by Professor Chris Salisbury on behalf of NHS Direct.

5 The Healthlines study. The focus of this project is the Evaluation of NHS Direct delivering telehealth interventions for long term conditions. NHS Direct staff are part of this research team. In June 2012 a family member of Professor Alicia O Cathain won a contract to offer patient feedback for NHS 111 sites in London. Dr Claire Ginn obtained the routine data for the impact analysis and analysed it according to instructions by Professor Jon Nicholl. Dr Ginn works for the Department of Health Commissioning Analysis and Intelligence Team. Acknowledgements We would like to thank: Professor Simon Dixon for advice about the economic analysis.

6 Neil Shephard for statistical help with the system impact analysis. Staff at NHS Direct (Trish Buckley, Annette Knipe, and Janet Cooke), and the North East Ambulance Service NHS Trust (George Marley, Sally McClure, Sonia Byers and Michelle Taylor) for their assistance in the administration of the user survey. The members of the expert panel who assessed calls. Funding This is an independent Report commissioned and funded by the Policy Research Programme in the Department of Health. The views expressed are not necessarily those of the Department. Evaluation of NHS 111 pilot sites Final Report Page 6 Glossary of terms Abandoned Call (NHS 111) A cal where the caller hangs up after 30 seconds from being queued for a call advisor to answer.

7 Ambulance call A call to the ambulance service for an emergency response originating from the emergency number, requests from other health professionals ( GPs, NHS Direct) or NHS 111. Ambulance incident All cases where an ambulance response is sent to and arrives at an incident scene. Auto-routed Calls routed from another service to NHS 111 without the need for the caller to dial the number 111 . Capacity Management System (CMS) Operates in real time, taking account of what is available and current activity. This enables a call for urgent care to be automatically matched to a service with the right skills, location and within the required timeframe at the time of the call.

8 Where adequate technical links can be set up, appointments or other contacts can be made by the call adviser at the time of the call. Directory of Services (DoS) Populated locally and jointly by service commissioners and provider services. The available skills of each provider are specified, as are service operation guidance such as location, referral protocols and opening times. ED emergency Department GP OOH General practice out of hours service Minimum Data Set (MDS) Routinely collected information on the efficiency and effectiveness of the different NHS 111 service models MIU Minor Injury Unit NHS Pathways Delivers a single clinical assessment tool that can provide triage over the telephone in any setting taking calls from the public.

9 NHS 111 Programme Board Set up by DH to oversee the strategic development and implementation of a new telephone based service for accessing urgent care . Ofcom The independent regulator and competition authority for the UK communications industries. Public launch Service became fully operational Soft launch Lasted for up to one month prior to the public launch and involved only taking calls that were routed from an existing number such as an out of hours service. During this time the service was not advertised to the public and so there were no direct dial 111 calls. SPA Single Point of Access A telephone number that manages all requests for urgent health services UCC Urgent care Centre WIC Walk in Centre Warm transfer A call transferred to a clinical advisor at the time of the call (without the need to call back) Evaluation of NHS 111 pilot sites Final Report Page 7 Executive Summary Introduction This is the Final Report of the Evaluation of NHS 111, a new telephone based service designed to help people access appropriate healthcare for urgent medical problems.

10 NHS 111 was developed in response to a review of urgent care that highlighted problems the public encounter when trying to access urgent care . The objectives of the NHS 111 service were to simplify access to non- emergency health care by providing a memorable number 111 that was free to the caller, provide consistent clinical assessment at the first point of contact, and route customers to the right NHS service, first time. The service is available 24 hours a day, 365 days a year to respond to requests for healthcare where the situation is not life-threatening and callers are unsure about what service they need, or they need to access care out of hours.