Policy responses and statements

Name of organisation:

NHS 24

Name of policy document:

NHS 24 Draft Strategic Framework 2009/10 to 2011/12 - "Delivering and Moving Forward"

Deadline for response:

13 March 2009

Background: NHS 24 is in the process of developing a Strategic Framework which will guide the delivery and further development of NHS 24’s services for the next three years, from 2009/10 to 2011/12. NHS 24 has written to the College as a key partner to ask for our input into this process.

The current NHS 24 Strategic Plan “Working for a Healthier Scotland” comes to an end in March 2009. In taking stock of the current position, NHS 24 knows that in recent years it has made important improvements to the services it provides with the valued support and input of its partners. Its unscheduled care service is now more robust and resilient and is working well in the provision of high quality services to patients in partnership with Health Boards. NHS 24 has also started to develop a range of health information and advice services.

NHS 24 is now looking at how it can develop the contribution NHS 24 services make to the NHS and health in Scotland. It is important that NHS 24 supports the work of NHS Scotland, Health Boards and the Scottish Ambulance Service in the provision of services to people across Scotland and it wishes to consider with you how this can be further developed.

The attached discussion document describes NHS 24's thinking to date and it would value input into this, not only with regard to the development of services in the out of hours period but also in how NHS 24 can support the broader delivery of key health improvement priorities across Scotland using its distinctive IT and telephony infrastructure, and the skills and experience of its staff.

COMMENTS ON
NHS 24
NHS 24 DRAFT STRATEGIC FRAMEWORK 2009/10 TO 2011/12 - "DELIVERING AND MOVING FORWARD"

The Royal College of Physicians of Edinburgh welcomes the opportunity to respond to NHS 24’s Draft Strategic Framework 2009/10 to 2011/12 - "Delivering and Moving Forward" and has sought, in particular, the views of acute and emergency physicians in compiling these observations.

The College would welcome the opportunity to review the evidence that supports the continued expansion of this relatively new service, particularly as this does not always concur with the professional experience of many doctors working in Accident and Emergency and Acute Medicine.  It would be very helpful to put this data into the public domain, as this would both encourage greater dialogue between the different healthcare teams delivering unscheduled care out of hours and increase the confidence of patients using the service, some of whom have been influenced by their own previous poor experience and that of friends and relatives.  Also, there is very little information in the discussion document on the costs of the service.

Specific Points

NHS 24 has six general aims, but the document includes a very wide ranging programme of work which takes many directions and may be unachievable at this stage.  The document is rather aspirational in this respect, and the College recommends that NHS 24 prioritises their core business and ensures services are working effectively before diversifying into other areas.

Aim 3 (Ensuring our Services are Effective) would benefit from an acknowledgement that their current algorithms continue to result in some patients reaching the incorrect destination for their presenting complaint.  There is also a very low threshold for inviting the patient to attend their local hospital.  The College believes these areas should be given greater priority in the future work programme.

The HEAT target to reduce A&E attendance requires NHS 24 to engage effectively with Emergency Departments and Emergency and Acute Physicians.  The College believes there is a need for greater dialogue between these services to ensure that patients who would be more appropriately assessed and managed in Primary Care do not self-refer to hospital Emergency Departments (in line with the policy intention).  However, Out-of-Hours Services in Primary Care must be adequately resourced to deliver this increased workload.  There is also little recognition within the document of the increased workload presenting in hospital Emergency Departments.

The College believes that NHS 24 must take action to re-engage with a large section of the Scottish population who have been ‘lost’ to their service.  Fellows who work in Emergency Departments have anecdotal evidence that a significant number of attendees in A&E present with Primary Care problems and have made no attempt to call NHS 24 during the out of hours period due to:

• lack of awareness, particularly of the on-line facilities
• previous poor experience when contacting NHS 24
• awareness of the experiences of others when contacting NHS 24
• adverse publicity. 
• dissatisfaction with advice given by NHS 24
• failure to receive a call back within the specified time period

The College recommends that NHS 24 undertakes a patient experience audit for those who present inappropriately at A&E departments.  This should be an important component of the quality assurance activity for NHS 24.

NHS 24’s practice of taking calls during the normal working hours has the potential to confuse patients who are already uncertain of which service to use (Primary Care or A&E). Unless managed carefully and in close discussion with the hospital emergency services and with Primary Care, much of the proposed activity on pages 15 and 16 could add to this confusion and duplication.

Achieving an appropriate balance between equity and local sensitivity is always a challenge. Scotland is a diverse country with diverse health care needs, and there is a danger that the NHS 24 model offers a very rigid approach to out-of-hours care.  Further exploration of local adaptations to suit local models of out of hours (unscheduled) care would be very welcome.

The document makes no mention of liaison with colleagues in NHS Direct (the equivalent service in England) and hopes that planners in both services are taking full advantage of learning lessons from their different experiences.

The College understands that the Emergency Care Summary has potential to be useful in secondary care and could be developed further.  Also, NHS 24 records of previous callers could provide useful “flags” to alert clinicians to potential problems eg medication issues or allergies.

Copies of this response are available from:

Lesley Lockhart,
Royal College of Physicians of Edinburgh,
9 Queen Street,
Edinburgh,
EH2 1JQ.

Tel: 0131 225 7324 ext 608
Fax: 0131 220 3939

[13 March 2009]