This consultation
What is NHS 111?
NHS 111 is a telephone-based service that aims to make it easier for people to access local NHS healthcare services in England. It is used when urgent medical help is required, but when this is not a 999 emergency.
NHS 111 services are staffed by teams of trained advisers who use NHS Pathways clinical decision support software and are supported by experienced nurses and paramedics. They ask questions to assess symptoms, then either give healthcare advice or direct callers to the most appropriate local service that can best help. That could be A&E, an out-of-hours doctor, an urgent care centre or walk-in centre, a community nurse, an emergency dentist or a late-opening chemist. When calls are more complex or require further clinical assessment they are put through to NHS 111 clinical advisors (who are nurses or paramedics). Around 25% of calls are handled in this way.
NHS 111 teams book appointments for callers and notify the receiving organisation by an electronic message. NHS 111 is available 24 hours a day, 365 days a year.
The proposals in this consultation relate only to NHS 111 services. These are all currently provided by NHS ambulance trusts or GP out-of-hours providers.
Why we are consulting
It is important that our new regulatory model assures patients and the public that they will receive the same standards of care across all services. We also need to ensure that our inspection methods proportionately reflect the differences between different types of providers, so that they do not experience a ‘one size fits all’ approach.
To achieve this, we have committed to align as many elements as possible of our new model for NHS 111 services with our model for other sectors, including hospitals, GP practices and GP out-of-hours services. It is important that we treat providers equally when they deliver similar types of services, but at the same time, we must ensure that we tailor our approach to each sector and type of service where there are differences that we need to take into account.
In April 2014, we consulted on our provider handbook for GP practices and GP out-of-hours services, which we published in October 2014. We have also recently consulted on our provider handbook for ambulance services. These handbooks describe in detail our approach to regulating, inspecting and rating services. The approach we set out in the handbook for GPs and GP out-of-hours services will also largely apply to NHS 111 services.
In section 4 of this consultation document, we have set out the aspects of our approach that we think should remain consistent across our inspections of NHS 111 services, irrespective of the type of provider providing the service. We are seeking views about whether we have judged those correctly.
In this consultation, we are not seeking feedback on our approach to other urgent care settings, for example, urgent care centres, walk-in centres or minor injuries units. We are already inspecting these services using our existing approaches for inspecting acute hospitals, community health services and primary care services. Where urgent care services are provided by NHS acute hospitals, they are inspected and rated as part of the urgent and emergency care core service. To support inspections of these services we will develop additional guidance, which any inspection team can use when inspecting urgent care services – irrespective of the type of provider.
In the longer term, we aim to inspect the integrated urgent care system within a local area. We are developing an approach that will assess how well care is integrated across health economies, focusing on the extent to which people receive high quality, caring and responsive services when moving within and across provider and sector boundaries. This approach will provide the framework for examining how urgent care services work together within local areas. We are working with providers of urgent care services, patient representatives and national stakeholders to develop how we do this and we intend to begin piloting this approach from September 2015.
Royal College of Physicians of Edinburgh
Care Quality Commission: Our approach to regulating
NHS 111 services
The Royal College of Physicians of Edinburgh (the College) is pleased to respond to the Care Quality Commission consultation Our approach to regulating NHS 111 services. The College represents Fellows and Members across the UK, with around 50% of our UK membership working in the NHS in England.
1. Do you agree with our proposed approach for regulating NHS 111 services? Yes / No
Generally yes.
- How do you suggest we gather people’s views of NHS 111 services?
- Are there other things we could take into account?
We agree that information should be collected from service users; however it would also be valuable to obtain information from the services that NHS 111 has an impact on, for example, GPs, pharmacies, A+E etc. There would be a need to advertise NHS 111 CQC inspection in each of these areas to encourage people to provide feedback.
2. Our inspections ask five key questions that aim to assure the public on how safe, effective, caring, responsive and well-led services are.
Do you agree that our proposed approach will do this for NHS 111 providers? Yes / No
Yes.
- Are the KLOEs, prompts, and ratings characteristics in the appendices appropriate for inspecting NHS 111 services? Yes / No
Generally yes.
- If not, what is missing or needs to change?
KLOEs seem appropriate; however recorded calls to 111 could be sampled to look at the KLOEs in detail.
- What do you consider to be the best ways that we can observe NHS 111 services and gather evidence about the quality of care they provide?
A prospective audit should be carried out, which includes modelling and cost effectiveness.
3. We propose not to rate NHS 111 services for the six population groups and only focus on the five key questions. Do you agree with this approach? Yes / No
The College has received mixed views from Fellows on this question.
It could be useful to use one specific population eg the frail older patient as a guide on how easy it is to navigate the service; as if this particular group finds the service easy to use then it is likely the other groups will too.
4. Where a provider delivers an NHS 111 service as well as other services, we believe that it is preferable to inspect the NHS 111 service during our inspection of that provider’s other services using our combined provider approach. Do you agree with this approach? Yes / No
Generally yes.
- How do you suggest we develop our approach to inspecting combined providers in this sector?
Some points that have been highlighted by Fellows include:
- The same action should be taken with regards to NHS 111 services irrespective of the nature of the provider to ensure parity.
- The rating system is well described, however there is some concern that poor ratings could be given to a provider who has one failure, and would then be treated the same as another provider who is comprehensively failing. It would helpful if there was clarification on how ratings would be applied to differentiate between these scenarios.