NHS Pathways to real efficiency

1. NHS Pathways to real efficiency Using NHS Pathways to drive efficiency into urgent and emergency care 03/05/12

2. Opportunities for Efficiency in Urgent and Emergency Care • Greater clinical integration between entry points • Matching patients to correct service • Reduced cost per call • Capturing real time demand data to inform commissioning • Capturing real time data to inform daily/weekly/monthly management of call taker performance

3. Urgent and Emergency Care Today 3am – what to do? 999 Not emergency? Queue and nurse ring back/re-triage Refer to Primary care via manual search of (paper) information NHSD Emergency? Transfer to 999 and re-triage GP Urgent? Transfer and re-triage Other? Prioritised Queue and nurse ring back/re-triage Refer via manual search of own directory GP Out of Hours Emergency? Transfer to 999 and re-triage Not emergency? Queue and nurse ring back/re-triage Tend not to refer to many other primary care services A&E District Nurse Minor Injury Unit Specialist teams Walk In Centre In Hours GP Out of Hours GP Specialist teams Other services

4. Greater Clinical integration

5. Commissioning Data • All searches on the directory are recorded providing commissioners with real demand data – • clinical skills needed • by time of day and • post code

6. Reduced cost per call • Traditional clinical decision support • Built for nurse use • But calls answered by call handlers • Two stage calls, with circa 80% requiring nurse assessment, significant volume of ring back needed • NHS Pathways: • Built to support initial call taker to perform appropriate clinical assessment for majority of calls • Fully enables nurse involvement as appropriate • Circa 20% of calls require transfer to nurse • Cost per call for 111 – around £8-10 with minimal (<1% ring-backs)

7. Commissioning Data

8. Using CQI data to maximise call taker performance • Any system is only as good as its users • In call centres, call length and sorting performance dictate cost per call – drives competition • NHS Pathways provides a CQI dashboard • Data automatically downloaded • Shows performance in key metrics of every user handling calls using NHS Pathways • Enables identification of high performers and those with opportunities to improve in key areas, such as Call length, referral rates etc.

9. CQI Data to manage performance improvement – A CASE STUDY • NHS Direct uses NHS Pathways to deliver NHS 111 services to four different areas. • As part of establishing best practices for delivering the 111 National Specification: • Developed a Management Operating Process (MOP) – all clear on their role, their performance requirements and how to monitor their own input. • Identified cohort of 30 high performers - supported to understand their own performance in key metrics, compared to the benchmark and the organisational average. • Source of performance data differences was identified to support targeted performance improvement. Buddying with high performers for a given metric enabled transfer of skills • Result since February: • >20% reductionin Average Handling Time for Health Advisors and Nurse Advisors • >10% reduction in need to hand off from Health Advisor to a Clinician

10. Conclusion • NHS Pathways is an enabling technology • Drives integration of urgent and emergency care • Supports significant efficiency and productivity improvement • Triggers close review of health care provision and provides data to support targeted improvements • Enables targeted monitoring of staff to maximise efficiency • It is NOT a panacea – the data is there – it needs to be used!