Folder NHS 111 and GP Out of Hours - Integrated Urgent Care FAQs

Extra Ordinary Board Meeting - February 10 2016

http://www.shropshireccg.nhs.uk/governing-board-meetings-2015

1)Why are Shropshire and Telford & Wrekin CCGs looking to integrate 111 and Out-of-hours services?

In September 2015 NHS England issued new national guidance about the need for a “functionally integrated” NHS111 and GP out-of hours service (OOH).

The aim is to provide a 24 hours/7 days a week urgent care access, treatment and clinical advice service that should work seamlessly. This would mean giving patients in need of care just one number to ring wherever they are, and that number is 111.

The CCGs believe this guidance, once implemented, will improve services for patients, make them easier to understand and improve access for everyone.

111 and OOH are largely integrated in most areas of the country.

2) Will the 111 number completely replace Shropdoc i.e will there still be an out-of-hours service locally?

The integration we are considering is about access to the services and ensuring people have access to the right service, including access to GPs out-of-hours. The CCGs will continue to commission  GP OOH services as well as  NHS  111, but ensure they both to work more closely together. 

3)  Why can’t the local number remain? It is clear the service is very popular.

The CCGs acknowledge Shropdoc provides a good service that is very popular with many patients in our area. This is evident in the support for the service shown in petitions and the engagement feedback.

However it is both confusing and wasteful to have two completely different means of accessing the same service. No area of the country operates with a different local number for emergency calls (999). This should be the same for patients needing to access urgent care.

There should be just one, simple means for anyone wishing to access urgent care, treatment and clinical advice to get help. The aspiration is to make this number – 111 – as universally recognised as the 999 emergency service, which has been used successfully since 1937.

4) How  would this service differ from the 111 and OOH services currently operating in Shropshire and Telford & Wrekin?

There are two separate issues here. The first is how people access urgent care, including GP OOH services. Currently patients have two means of accessing out-of-hours care – they can call NHS 111 or they can call the current GP OOH services directly on their own number (0333 222 66 55).

In future access to urgent but not life threatening care will be via 111. That is national guidance and local NHS commissioners agree it is right.

David Evans, Chief Officer for Telford and Wrekin CCG said on BBC Radio Shropshire recently, "The idea of having a single 111 number is fundamentally right - what happens afterwards is most important."

This aligns very closely with a recent letter from Shropdoc’s Chairman Dr Russell Muirhead in which he said: “Whilst the 111 service is a nationally mandated service which should make access for patients easier and simpler, an aspiration which Shropdoc supports, what happens beyond that initial call is critical to the service that a patient …. might receive.

The second issue is who provides the GP OOH services if, following a telephone assessment, this is the appropriate service for the patient.

This could be Shropdoc without the separate phone number and telephone triage.

However the CCGs  are considering whether Shropdoc should be allowed to continue delivering this service or whether there should be a retendering process. By retendering this would mean that we invite any potential bidders (including Shropdoc) to compete for the service.

5) Why are we considering retendering the OOH element?

Shropdoc has been delivering this service since 1996 and it is highly unusual for a single organisation to provide such a service to the NHS for a period of 20 years without being subject to a re-tendering process.

Virtually all NHS contracts are subject to re-tendering to ensure that services offer quality for patients and value-for-money for the NHS.

This is basic good practice, but there are also laws and regulations that govern this, including The Competition Act 1998 and The National Health Service (Procurement, Patient Choice and Competition) Regulations 2013.

Any decision on re-tendering would need to comply with these national rules and regulations.

6) We have been informed that the CCGs have already decided that they are definitely retendering Shropdoc

No decision has been made about whether Shropdoc will be subject to a retender, at this stage the CCGs are considering what their options may be.  That decision will be taken at this meeting.

7) If a new organisation is brought in to run GP OOH services they will not have the same local knowledge as Shropdoc.  Shropdoc is the organisation with the local knowledge. 

The CCGs have a duty to ensure that local patients are getting the best possible service. If the CCGs decide to go out to tender then Shropdoc will have every chance to demonstrate they are best placed to provide it.

As part of the any tender process , providers will need to  show that they can  achieve all the means of providing a high quality service. The message about the need to ensure local knowledge, especially in rural areas, has been heard very clearly in the feedback from our engagement exercise and documented in the engagement report which is being considered today and which everyone at this meeting has access to.

8) If you integrate 111 with out of hours will this mean I won’t have any face-to-face contact and will only be able to speak to a doctor or nurse in another part of the country on the telephone?

The correct model of care for Shropshire and Teford & Wrekin has been looked at carefully. We have concluded that the majority of GP, Advanced Nurse Practitioners and community nursing input should and can be locally based, both to advise on the telephone and to make OOH home visits if necessary.

9) We have heard that WMAS (West Midlands Ambulance Service) have been told they cannot retender for 111, which they used to run, and that the contract is  going to a private company in Newcastle-upon-Tyne.

This is completely untrue. The process will be subject to strict regulations to ensure it is fair and transparent.

10) If Shropdoc is not the first point of call anymore, patients will not have direct access to a doctor/nurse in the way we do now, i.e the phone will not be answered by a medically trained person.

Currently calls to Shropdoc are answered by trained call handlers, not doctors or nurses.

They take basic details in order to identify the most appropriate course of action depending on the needs of the patient. Options can include a call back from a GP or nurse, arranging an appointment to see an OOH GP at a convenient base, a home visit from an OOH GP, or the call can be refered to the 999 service if it is assessed as being an emergency.

This is very similar to the way NHS 111 operates. All of these options will remain.

We need to stress again that Shropdoc could still provide the GP OOH service for Shropshire and Telford & Wrekin, even if the decision is to go out to tender for the out-of-hours service.

11) Campaign Group Shropshire Defend Our NHS recently described NHS 111 as “discredited” and the service was recently blamed for the death of baby William Mead

We do recognise that when NHS 111 first rolled out in 2013 it did experience problems. However, since then it has continued to develop and improve.

Currently the provision of the NHS 111 service in Shropshire and Telford & Wrekin is subject to a wider regional tendering process being led by Sandwell and West Birmingham CCG, with the intention of the new contractual arrangements commencing at the end of October, 2016.

Strict performance monitoring will form part of this contract to ensure the services delivered meet the quality standards we have set out in the contract. 

We want a service that delivers high-quality care and advice and meets the standards we require for local people.

12) Is this all about cost-cutting and not patient safety?

It is about improving the service, in line with the new national standards, and with our own aspirations for local people.  It is about ensuring that there is an urgent care service that everyone understands and knows how to access, and making sure there are clear and consistent messages for patients –  call 111 and you will be given advice or directed to the right service.

This will also have the benefit of reducing duplication and increasing efficiency and effectiveness.

From a patient viewpoint, all calls to NHS 111 are completely free.

13)  Why was the consultation period so short? And what has happened to the results?

The CCGs have conducted an engagement exercise not a consultation process – legally they are two different things.

The purpose of the engagement exercise was to provide information which is set out in

Engagement and Equality and Analysis Report which is available to you today. This information has helped form the recommendations that the CCGs Boards will consider today.

Even though the engagement was held over a short time we received  a good response. It was promoted through briefings,  by Shropshire & Telford and Wrekin Healthwatch,  and through Shropshire Star. We also held “equality listening events” where we talked to groups of people with specific health needs. We also received feedback via email and by post.

The Engagement and Equality Analysis Report is available on the CCG websites.

14) Why were the costs of the two options of having either a 111 or Shropdoc service not published as part of the consultation so we could decide which one to vote for?

The CCGs are not making a choice between 111 or Shropdoc.  To clarify both 111 and OOH services are required. 

If a potential tender process is being considered then the costs of the existing service provider are not disclosed, as it could give a commercial advantage to other potential bidders.

15) Is this another example of privatisation of the NHS?

Shropdoc is a not-for-profit company and not an NHS organisation. We would again emphasise that Shropdoc has not been “sacked” or barred from providing the service.

Any retendering process, should this be the CCG’s decision, will provide a level-playing-field for any interested parties. Shropdoc will not be disadvantaged in any way.

16) The recent survey on NHS111 and OOH services carried out by the two CCGs showed overwhelming support for Shropdoc. Has this been noted?

Yes.  As you can see, The Engagement and Equality Analysis Report acknowledges this. The petitions collected will be presented to the CCGs today and are acknowledged in the report.

However the popularity of a current provider with members of the public cannot be the sole influence in the decisions that the CCG  need to take.

The CCGs have a binding duty to ensure their populations receive the best healthcare within the budgets they are given, which requires the CCG Boards to balance patient opinion with other issues. These issues include the quality of services, how patients access services, the law which governs how contracts are awarded, and affordability.

16) What happens next?

The governing bodies of both CCGs will consider the recommendations made to them today.

If they decide there should be a  re-procurement process, it will be thorough and transparent. We expect to make a decision so work on achieving  new joined-up, integrated NHS111 and GP OOH service can start straight away.

This will be managed by a Project Board which reports to the governing bodies of both Shropshire and Telford & Wrekin CCGs.