Dr Brian Gaffney, NHS Direct medical director asks GPs to consider how NHS Direct can work with GP commissioners on urgent care
You will probably know that NHS Direct has been providing health information and advice to patients through its telephone and the web services for 12 years, but did you know that we've been using this experience to develop and deliver the first NHS 111 pilots to test the service? We haven't been doing this alone. The first-wave pilots to test the service have given us the much-welcomed opportunity to work closely with local Ambulance Services, GP out-of-hours providers, Primary Care Trusts and Strategic Health Authorities. Only by working together and pooling our expertise and resource can we make NHS 111 a success for patients when the service is rolled out nationally. In two of the pilots, we are delivering the end-to-end service, with our trained health advisors answering and triaging calls using NHS Pathways. Where necessary, calls considered ‘warm' can be transferred to NHS Direct nurse advisors for further assessment and advice. Where appropriate, callers can be referred to face-to-face services using a directory of local services and, if required, appointments can be booked with the GP out-of-hours provider or an ambulance dispatched.
Our vision for NHS 111 is simple; we want it to be the patient's ‘front door' to non-emergency local care services. It also needs to fit into the existing urgent care landscape and build on the services patients already receive. It goes without saying that the service needs to be clinically robust, easy to use and, of course, cost effective; but we need to ensure that, like NHS Direct, NHS 111 continues to take pressure off vital face-to-face services such as GP surgeries and A&E departments. The way it will do this is by continuing to promote self-care where possible and continuing to have a clinical nurse-led presence.
NHS Direct's 0845 phone number will no longer exist in two years, but NHS Direct as an organisation intends to have a new role, as a major provider of the new 111 service as part of the 'any willing provider' commissioning model. This will be a good opportunity to work alongside our GP colleagues. A major focus for us over the next year is to engage with the emerging GP consortia showing them all that we do and how we can work together, not just when delivering 111 but when meeting the demands that will inevitably come out of the new GP commissioning arrangements. It goes without saying that any service that we develop would be in response to what local commissioners want, and only if we could provide a good service for patients.
Early discussions with emerging GP consortia have been around the range of telephone and web-based services we could offer, to support their practices and meet the needs of people who want to access healthcare differently. For example, our online health and symptom checkers can be made available through GP practice websites so patients can self-assess their symptoms to understand if they really need to see their GP or if their problem can be dealt with through self-care advice that the tools can provide.
GPs have highlighted to us the importance of sharing our knowledge in a clear, concise, and usable way so that they can make more informed decisions about commissioning healthcare in their area. With this in mind, in 2008 we developed a ‘segmentation' of our patients which identified seven distinct patient groups across England. This was based on the wealth of knowledge we have about the millions of patients who contact NHS Direct every year. Each group had a unique set of behavioural characteristics which influence how they access urgent care. We have looked at how groups of patients in different postcode areas currently use their local healthcare services - including NHS Direct - based on their behaviour traits, exploring whether there is potential to safely pass on certain groups, in certain areas, to more appropriate, cost effective healthcare channels.
We have been working to make our patient segmentation information more locally-focused, and we currently have detailed information about each PCT. We hope to soon also be able to report this information at a GP practice level. Our aim is to share this information with as many GP commissioners as possible and for it to be a helpful resource with the redesign and planning of local urgent care services, or to gain a better understanding of how people use urgent care services. One key driver of the 111 service is to improve access to care, and we can use this analysis to highlight where segments of the population who are likely to use the 111 service live; we can also help commissioners target segments of the population who are likely to inappropriately use face-to-face care, so that they can access more appropriate channels through 111.
It's fair to say that our relationship with some GPs has not always been an easy one. However, with NHS Direct set to play a major role in the urgent care landscape in the new world of NHS 111 and in these times of change - more so for GPs than any other health professional - I believe it's time for GPs to look again at NHS Direct. Look at how we have evolved over the last 12 years, our plans for the future, and how we could potentially work together to support patients.
