Organisation develops a 111 support service for patients requiring acuity and urgent care, carrying out emergency medical assessments and reducing patient journey time

Synopsis:

Workforce and service pressures were cause for the incumbent 111 provider in Somerset to ask the Commissioners for help over the busy Winter period. Predicted performance levels were poor, with real concerns over providing a service, care and patient safety. The Commissioners turned to Devon Doctors (DDG) in October, they shared the untenable situation and asked if DDG could provide a solution – to present ideas, design and deploy a solution within 8 weeks.

This was an extremely big ask; however, minded that something must be done and focused on putting patients first, DDG innovated and deployed a solution that went live in just 6 weeks… the 111 Support Service was created. The results of this unique, patient centred service are incredible, for both the entire network of care providers across Somerset and, most importantly, the Somerset communities and patients themselves.

Challenges:

111 Support Service is designed to prioritise and deliver high quality and appropriate care to high acuity, urgent care patient cohorts. To achieve this, working collaboratively with the Commissioners, DDG set up a tripartite partnership of 111 providers, who work together to answer patient calls. Patient groups are identified by a new IVR, designed by DDG, that streams Under 1 and 75 & Over patients directly into the CAS. For these high acuity patients, DDG developed a completely new 111 call handling process, designed by clinicians and contact centre professionals, to create a slick, efficient and safe series of pathways to get patients to a CAS clinicians as quickly as possible.

The Emergency Medical Assessment (EMA) and Call Handler Risk Identification System (CHRIS) where created, delivering a patient to the CAS GP clinical queue within 3mins (5min saving when compared with Pathways). Within the 6 weeks DDG had to design and deploy the service, in addition to creating from scratch the patient pathways, 30 new call handlers needed to be recruited and trained. This was a significant undertaking, but one DDG achieved and, minded of how important this new workforce was to the success of the initiative, engagement and valuing these colleagues has been the top priority – results include attrition of only 7.5%, with industry standard at 30%.

Outcomes:

The 111 Support Service, provided by DDG, has been the highest performing 111 service across the UK for December 2018. Despite being the busiest period of the year for the Urgent Care Service, in December DDG answered 93.3% of patient calls within 60 seconds. This has been widely recognised as an outstanding, market leading performance.

Add to this a 5 minute saving in journey time for the high acuity Under 1 and 75 & Over patients, and the benefits of this unique, tailored and patient focused service start to become very clear. Patient Story… Mother of a 4 month old called 111 at 08:10AM on Saturday, her call was answered immediately by the DDG’s 111 Support Service.

The EMA and CHRIS assessments were completed professionally and efficiently, with the child’s symptoms identified as Cold / Flu and an ‘Urgent’ (20 minute) priority placed on the case. The case was passed to the CAS GP at 08:14AM, who contacted the patient at 08:24AM to arrange an urgent Treatment Centre appointment. The patient attended the DDG’s Yeovil Treatment Centre for a face to face consultation at 08:45AM, where the GP assessed and treated the child. This patient journey from start to finish was 35 minutes… an exceptional patient journey for a poorly child.

Spread:

In order to develop and implement this service, DDG have worked collaboratively with SWASfT as part of the EMA process, Somerset CCG, Dorset 111 service and partner 111 providers. There have been considerable benefits felt by the wider care network, inclusive of the improved holistic performance of the Somerset 111 service and patient experience – calls abandoned have been comfortably below 4% everyday (pre-111 Support Service predictions were over 15%).

One of the biggest successes has been the ambulance referral rate. Minded of the pressure experienced by the ambulance service during the Winter period, DDG gave real focus and development to how patient referrals from urgent care to the ambulance service and ED care could be limited to true emergencies only. Due to the extremely swift GP patient access provided by the 111 Support Service, the EMA was modelled to present emergency patients only to SWASfT.

The results achieved are industry leading and recognised by SWASfT, who benefitted from circa 600 less ambulance referrals during December across Somerset. DDG’s 111 Support Service achieved 6.6% ambulance referral rate, compared with circa 18% through Pathways for the same patient cohort.

Value:

Calls Answered within 60seconds – 93.3% - BEST PROVIDER PERFORMANCE. Calls Abandoned over 30seconds – 1.5% - BEST PROVIDER PERFORMANCE. Ambulance referrals – 6.6% - BEST PROVIDER PERFORMANCE. Employee Attrition – 7.5% - BEST PROVIDER PERFORMANCE. As a result of DDG stepping in to support the patients of Somerset the 111 Support Service, mobilised from concept to full deployment within 6 weeks, was created and have proven a market leading service provision within Urgent Care. Patient experience is extremely positive, the model delivers 100% of high acuity patients to a clinician and the benefits to the wider care network are exceptional – ambulance referrals reduced, ED referrals reduced and patient journey times reduced.

Involvement:

Our stakeholder were the patients of Somerset; specifically those over 75 years of age or under one. A full equality and quality risk assessment was completed and was deemed to deliver only positive impacts by the CCG assurance board. We have engaged with the ambulance trust (SWAST) with regard to our plans - They are hugely supportive as we have reduced ambulance dispoisitons from this cohort of patients by a huge margin of 70%.

We have met with the pan-Somerset Patient Participation Group (PPG) which includes representatives of all PPGs in the county and shared our model; they were universally supportive. Staff were given a full weeks training with specific on-boarding slots run by our clinical lead and our Head of Operations - Feedback has been tremendous.