More clinicians and greater links to specialist care providers is improving patient experience and relieving pressure on emergency departments within the North East.
NEAS was successful in obtaining funding from the region’s Urgent and Emergency Care (UEC) Vanguard in building up a regional Clinical Assessment Service (CAS) with support from a network of local providers as part of an alliance.
The core CAS is provided by NEAS, with specialist support, such as pharmacists, dental and mental health, provided by alliance providers to provide more timely appropriate care to patients.
Original opening times for the CAS were based on the busiest periods of the NHS111 service and where it was felt there would be the greatest impact from enhanced clinical assessment. However, as the CAS expands, there are plans to extend the opening times into the full out of hours period. There are also plans to bring more specialists, such as pharmacists, into the core team.
One of the key services provided by the CAS is a focus on patients who are advised to attend an emergency department at the end of the triaging process.
In hours, low acuity patients are reviewed by band 6 clinicians to assess whether alternative transport can be found or whether the patient might be treated via an alternative pathway, such as referral to GP, OOH service or self-care.
Out of hours, patients are reviewed by a mixture of advanced practitioners (APs) and GPs working within the core CAS, who are able to provide telephone advice and direct patients to alternative services.
GPs and APs also provide consultations for NHS111 patients who are advised they need to speak to a primary care professional within a defined timeframe
The CAS also operates a service for mental health patients, with pharmacy pathways, dental pathways, and direct lines to clinicians for healthcare professionals currently underway.
As a result of these interventions, referrals to emergency departments from NHS111 have reduced considerably, from 6% in May 2016 to 3% in October 2017, below the 5% national target. Around 130 mental health patients are also being directed straight to a local crisis team and 43% of ‘speak to’ dispositions are re-routed from a same day service and to self-care.
There is also a gradual increase month on month of use of alternative transport and alternative services.
Patient satisfaction has also improved since the introduction of the CAS, with 90% of callers recommending the NHS111 service between July and September 2017.