Testing the Directory of Services (DoS)

1. Testing the Directory of Services (DoS) Gavin Reader – CMS Regional Lead Ross Hamilton – BNSSG DoS Project Manager

2. Event schedule

3. Objectives • Ensure the expected services are returned for normally expected scenarios • Test rarer scenarios, to identify where appropriate existing services are not returned • Reinforce stakeholder confidence and commitment

4. Building the DoS and how it works! How 111 works with the DoS Building the DoS NHS Pathways – outputs a disposition or ‘DX’ code (NOT WHAT WE ARE TESTING) Project Board – approves which DX codes go to one of four locations 1)999 2)111 i.e. stays in house 3)DoS 4)Self-care Commissioners – decided what services would meet those needs Providers – completed supplied profiles of what their services do, these are then uploaded to the DoS

5. Building the DoS • Process involved in building the DoS: • Commissioners asked to identify services that are likely to be required through the 111 system. • DX Mapping. Outcomes from NHS Pathways vs local healthcare services • Urgent Care Services able to respond to the patients needs within 2,6,12,24 hours • Patient facing – does not require another healthcare professional to access the service • Commissioners or Providers to provide: • Demographics of the services. (Address, contact details, Opening hours) • Clinical Details. (Profiling) • Restrictions around GP registered patients • Worth Remembering that not every service within the Health Community is currently on the system.

6. DoS Profiles • Profiling is vital to ensure the DoS provides the appropriate services to the 111 call advisors. • The process to ensure this has been completed correctly is: • Type 1 Services have been profiled using the National Template • Type 2 Services have been profiled by the providers • Commissioners / CAC asked to verify demographics of each and every service (Address, contact number, opening hours). • Commissioners / CAC ask to verify profiling for every service • QDoS testing (explained later) • End to End Testing • ‘Break the system Event’

7. QDoS • Automated test to ensure the correct services return for a set of pre-defined scenarios. • Can only be run by the CMS Regional DoS Lead. • The scenarios are produced by Connecting for Health – based on calls received by the 111 pilot sites around the country. • Works on returning the top two services from each team type that are appropriate, irrespective of the time of day the test is run. • Works on GP restricted services and the patients postcode (37 mile radius) • We will use the test to identify the ‘type’ of service returned is correct – Not every service entered onto the DoS!! • NB: This is a requirement for ‘DoS readiness’ that is signed off by the DH

8. QDoS Example • Vomiting Scenario: • Dx05 : The individual needs to be seen by the GP practice or other local service within 2 hours. If the practice is not open within this period they need to be seen by the out of hours service. • Symptom Group:  VomitingSymptom Discriminators: non-trauma full Primary Care assessment and prescribing capability • Call Report Patient: Joe Bloggs, Age Gender Selected: Adult, MaleSignificant blood loss was not described.Fighting for breath was not described.A heart attack, chest/upper back pain, recent probable stroke, recent fit/seizure or suicide attempt was not described as the main call reason.New confusion, a diabetic hypo, a probable allergic reaction was not described as being the main call reason.The individual was not described as feeling cold to touch.Pathway Selected: PW939, VomitingDiarrhoea as well as vomiting was not described.Vomiting blood was not described.Vomiting after drinking alcohol was not described.A head injury in the previous 3 days was not described.Abdominal pain was not described.Vertigo was described.

9. QDoS Example Cont…. • Dx05 : The individual needs to be seen by the GP practice or other local service within 2 hours. If the practice is not open within this period they need to be seen by the out of hours service. • GP - Yeo Vale Medical Practice (Yatton) - North Somerset (Home GP) PostCode: BS49 4ERDisposition Instructions: Out of hours provided by Harmoni - 0845 121 0235 **GWAS Contact number only** - 01934 839820 • Community Team - Strawberry Line - North Somerset PostCode: BS40 5JDDisposition Instructions: 111 Call Advisor must phone prior to the service accepting the referral Phone numbers 8am-5pm, then Carelink number 5pm-10pm Carelink number all weekend. Will Only accept patients over the age of 18 • GP in Urgent Care - (Harmoni) - North Somerset PostCode: BS23 4TQDisposition Instructions: • GP - Yeo Vale Medical Practice (Congresbury) - North Somerset PostCode: BS49 5DXDisposition Instructions: Out of hours provided by Harmoni - 0845 121 0235 **GWAS Contact number only** - 01934 839820 • WIC - Harmoni (Weston Healthcare Centre) - North Somerset PostCode: BS23 1NADisposition Instructions: • WIC - Harmoni (Weston General Hospital) - North Somerset PostCode: BS23 4TQDisposition Instructions:

10. ‘Break the System Event’ • A few key aspects to remember: • Urgent Care / patient facing services currently in the system • System is ‘Time of Day’ dependant – No OOHs services returning • We are trying to mimic the NHS pathways algorithm. Think about the profiling terminology. • We are looking to enter scenarios that we expect our service to return for or ones that we know our services should not return for. • Only Use 6.4 / 6.5 Symptom Groups – Ignore AMB Symptom Discriminators • Ranking is based on National Ranking – Mileage • If you identify an issue PLEASE let us know.

11. Example • How to use the system demonstration: CMS DoS - www.pathwaysdos.nhs.uk Account Username and Password: gwtestaccount

12. Example Cont…… Leave this box as it is. Patients Postcode. Format xxx xxx Leave for Open Access Patients For services restricted to GP surgeries: Un-tick the ‘Unknown Box’ Enter first 3-4 letters of GP Surgery Click on required surgery from the pop up list Enter first 3-4 letters of a symptom until drop down list appears Select required Symptom Group Select required Symptom Discriminators Enter Urgency of the Patients condition