NHS 111 First is a national programme that aims to improve the way that patients access urgent care by ensuring that they receive the right care in the most appropriate setting first time. Based on ‘talk before you walk’ principles, the programme will focus on using NHS 111 to reduce unnecessary attendances at Emergency Departments by supporting the public to access the most appropriate services in their area. The programme allows NHS 111 to book patients directly into a variety of services out of hospital – including primary care – and within assessment areas within acute hospitals. NHS 111 will also be able to book patients into the Emergency Department (ED) when it is best for their needs.
- The NHS is finding different ways to see patients.
- We are still in a COVID response so it is important we keep staff and patients safe when they come. EDs are very busy and this is combined with having less space due to social distancing measures.
- Many patients attending ED could be treated elsewhere.
- By allocating time slots to patients we can reduce crowding in our EDs.
- Patients are going to be encouraged to call NHS 111, or visit NHS 111 online, before walking into an ED.
- NHS 111 can assess a patient’s symptoms and refer them to a different service if ED care is not required. These services include GP practices, Urgent Treatment Centres, hospital clinics and other same day emergency care services. Patients might also be referred to their pharmacist or asked to self-care.
- Patients who walk into ED but who are triaged and deemed to not require emergency treatment are going to be signposted to other services, and in some cases can be booked into appointment slots for those services.
- Patients referred to general practice will be told that they will be called back by the practice within the disposition time frame. So, for example, for a “contact local service within two hours” the patient will be told that they will receive a call back within two hours. That is from the time that the patient is actually booked for the slot.
- Patients referred to their GP practice will be contacted by telephone to discuss their healthcare needs. This ensures that only those who need further care (in-person or via telephone/video consultation) are presenting to services and they are managed as appropriate for their clinical condition.
- No patients will be turned away from an ED if they decide that they wish to have their care provided there.
What will be different for patients?
Patients will be encouraged to visit NHS 111 online or call NHS 111 before they attend an ED if their requirements are not an emergency. Emergency patients in potential life or death situations should continue to call 999. Patients visiting NHS 111 online or calling NHS 111 will have their symptoms triaged and they will be provided with advice about which NHS service to use. Sometimes, this might be the ED, but NHS 111 will also be able to offer appointment slots for other services, such as general practice and Urgent Treatment Centres (formerly called minor injury units) as well as providing advice that a patient might need to visit a pharmacy or another service. NHS 111 will also be able to advise patients to bypass the ED and attend a specialty clinic within a hospital when appropriate.
Can patients still walk into an ED?
Yes – and ultimately no patients will be turned away. However, patients attending EDs without an appointment slot booked for them via NHS 111 will be triaged by the GP streaming service at the ED front door and may potentially be given an appointment with a different service. No patients will be turned away from ED having walked-in without an appointment slot.
What about patients who find it difficult to communicate or understand?
We appreciate that some patients may have communications barriers, such as patients with a learning disability, patients who have had a neurological condition or a stroke, or patients whose first language is not English. NHS 111 will be able to note in the patient notes that transfer with the booking whether the patient requires an interpreter though consideration should be given to allowing these patients to bypass the NHS 111 First approach.
Why are we changing now?
There are now two things happening that mean that we need to be more assertive in our ‘111 first’ messaging. The NHS 111 service is developing and will be able to book patients into time slots, including in an ED. Attendances at EDs are rising quickly and they have significantly reduced space for waiting and seeing patients. All parts of the country are developing the capability for NHS 111 to book into a variety of services, other than primary care. This is based on a significantly expanded national directory of services available to NHS 111, with improved technology enabling NHS 111 to book directly.
When does this come into effect?
NHS 111 in Derbyshire can now, if required, book patients into a timed slot at one of our EDs as well as at an out of hospital service depending on which may be more clinically appropriate for their need.
- Assessment areas within acute hospitals such as same day emergency care clinics
- Mental Health Triage Service
- Primary Care
- Urgent Treatment Centres
The NHS 111 First systems are currently being tested ahead of a national campaign starting in early December.