Clinical Governance of the 111 Service

1. Clinical Governance of the 111 Service Dr S Rawstorne 111 Clinical Governance Lead BNSSG

2. Completion of clinical assessment on initial call Refer callers to other providers without re-triage Transfer clinical data to other providers and book appointments where appropriate Ability to dispatch an ambulance ‘without delay’ Core Principles of 111

3. Benefits of 111 Improving public access to urgent healthcare services Increasing the efficiency of the NHS Increasing public satisfaction and confidence in the NHS Enabling more effective commissioning of services Increasing the efficiency of 999 ambulance service

4. Clinical Governance for 111 Particular challenge – many providers involved Ensure safety of whole patient pathway “Clinical governance arrangements must be in place to ensure the clinical safety of the whole patient pathway, not just the 111 call handling service. Strong relationships and partnership working should be established between all providers involved in the pathway so that issues can be identified and service improvements made.” Build and maintain relationships between providers “Clinical governance should also establish the levels of understanding and trust between the many different providers who meet people’s urgent and emergency care needs that underpin the delivery of high quality, 24/7 integrated urgent and emergency care. “

5. Role of the Clinical Assurance Committee To support the CG Lead in developing the Clinical Governance Submission To provide a multidisciplinary forum across patient pathways To provide ongoing reviews of data to assure the commissioners and public about the quality of the service. This includes: Ensuring that there are robust systems to manage repeat callers especially where repeat calls might signify a significant health or safeguarding problem. To ensure that the service and its staff are alert and act upon potential safeguarding issues in children and vulnerable adults; That feedback from patients and health professionals is systematically analysed and supports service improvement; Ensuring that the quality of information about use of services within the DOS to inform commissioning To ensure there is ongoing assurance of the quality of call handling, health advice, clinical advice and outcomes; To make recommendations as to how commissioners might use 111 to further improve patient care.

6. Clinical Governance Submission First stage - the local NHS 111 team submits a set of papers which describes its particular approach to the clinical governance of its service, supported by a formal endorsement of that approach by the Senior Responsible Officer. Second stage - Dr Nicholas Reeves, with either Dr Noble or Dr Livingstone, will meet with the local team to discuss with them face-to-face their approach to the clinical governance of their service. Third stage, Professor Matthew Cooke, the National Clinical Director for Urgent and Emergency Care considers the report and recommendations from Dr Reeves and Dr Noble or Dr Livingstone The outcome is either that some remedial action is required before the service goes live, or that he accepts that the clinical governance arrangements are appropriate and safe and that, from that point of view, there is no reason why the service should not be launched. 

7. 111 Timelines Award of contract to 111 provider First stage submission of clinical governance arrangements – 20/12/12 ‘Soft launch’ All GP OOH calls diverted to 111 -19/02/13 ‘Hard launch’ 111 service available to general public – 19/03/13