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Introduction

Introduction. In 2001, SEHD commissioned an external evaluation of the introduction of NHS 24 The aim was to examine NHS 24 activity and its impact on other services patient perspectives of the new service, the cost of the NHS 24, and the process of implementation in the first site.

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Introduction

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  1. Introduction

  2. In 2001, SEHD commissioned an external evaluation of the introduction of NHS 24 • The aim was to examine • NHS 24 activity and its impact on other services • patient perspectives of the new service, • the cost of the NHS 24, • and the process of implementation in the first site. • NHS 24 was introduced first in NHS Grampian in 2002, with an ambitious roll-out programme across Scotland, which was completed in late autumn 2004

  3. Prior to NHS 24…. • widespread variation in the organisation of out-of-hours primary medical care in Scotland. • NHS 24 had to integrate the new service into a complex organisational landscape. • NHS 24 was distinct from NHS Direct • commitment to a national service • Integration with partner services • commitment to front all GP out-of-hours calls.

  4. Activity

  5. NHS 24 activity By April 2005, NHS 24 had logged 1,914,176 calls on its Patient Relational Management (PRM) system: 250 per 1000 patients per year, higher in the West (286 calls East (226 calls) and lowest in the North (221 calls) Almost 60% of calls concerned females, 60% of calls were made on behalf of someone else 17% of calls concerned babies and children under the age of 5 and 12% of calls were for over-75 year olds 90% of all calls to NHS 24 were in the out-of-hours period OOH dispositions: contact GP services within 4 hours (55%), followed by home care advice (14%), making a daytime appointment with a GP (9%), going to A&E (5%) or being told to make a 999 call (3%).

  6. Out-of hours, 3% of calls to NHS 24 were for health information, during daytime hours, one-third of calls were for this reason. Between January 2003 and January 2005 the level of call back increased from 2% to 34% of calls rising to 53% in March 2005, but decreasing to 34% October 2005 (and has since been dramatically reduced). Outcomes became more standardised post NHS 24 Also responded to partner concerns about urgent triage

  7. Out of Hours Services All organisations changed ownership and structure during the course of the study, due to the introduction of the new GMS contract (nGMS). The number of primary care out-of-hours contacts rose slightly (may have occurred in any case) 40% of calls were handled by NHS 24 without the need for further action by GP OOH services. This resulted in a reduction in contacts

  8. Accident and Emergency (A&E) There was no evidence of an increase in overall A&E activity due to the implementation of NHS 24. In areas where A&E activity was increasing, this was apparent before the introduction of NHS 24. In other areas activity levels remained stable. Some evidence of changes in the ratio of out-of-hours to in hours activity percentage of A&E attendances from NHS 24 was small (ranging from 2% to 10%)

  9. Scottish Ambulance Service (SAS) There were large differences SAS activity in the areas studied; the introduction of NHS 24 had no clear impact on call volume There were small increases in the proportion of out-of-hours calls in Grampian, Dumfries and Galloway and Lothian. NHS 24 was not a major source of calls 8%-14%

  10. Patient Satisfaction

  11. PATIENTS’ VIEWS OF NHS 24 Postal questionnaires Grampian, Greater Glasgow, Lothian, Highland and Dumfries and Galloway. Majority of patients (85%) reported finding it easy or very easy to contact the service. Most people contacted the service because they perceived their problem to be urgent, causing pain and/or anxiety. However, there was an increase in people contacting NHS 24 for information and those who felt that it was more convenient than contacting their own GP. Expectation of receiving a home visit decreased

  12. Patient satisfaction with services pre NHS 24 was high approximately 90% of respondents reporting themselves “satisfied” or “very satisfied” with their contact. Satisfaction remained high post NHS 24 in surveys conducted early in the roll-out of the service, but declined in later surveys Being called back was associated with a decrease in overall satisfaction Satisfaction was lower in rural board areas

  13. Economics

  14. THE COST OF NHS 24 Total cost of NHS 24 over the period 2000 to 2005 was £126,126,000 : capital and set-up costs were £25,243,000. The average total cost per call in 2004-2005 was £35.69, of which capital costs were £2.93 per call and revenue costs were £32.76 per call. The average annual cost of NHS 24 per person in Scotland for 2004-2005 was £8.98. This average cost per call must be viewed in context.

  15. Implementation Process

  16. Support from partners for the concept but it was acknowledged that integration of the service in Grampian had had particular challenges, being the first site. Timing of integration was important, with Board areas which integrated in the middle of the roll-out or who did not experience a phased roll-out, experiencing fewer problems and issues. The new GMS contract and the GP opt-out from the provision of out-of-hours services contributed to difficulties in meeting demand. During 2005, NHS 24 put in place a range of quality initiatives to address partner concerns.

  17. Discussion

  18. Constant development for NHS 24, with unexpected issues arising, in particular the new GMS contract. During 2005, NHS 24 was the subject of an Independent Review and instituted a Transformation Programme Prior to the introduction combination of variable service delivery and strong professional cultures. The state of readiness for a national, standardised service varied. The challenge of integrating with existing health services was under-estimated in the development of NHS 24. There was much that was new about NHS 24 and some of the ambition in the original Blueprint was unrealistic. High expectations at the outset of the service.

  19. much higher proportion of calls OOH consistent, high quality service :overlook the importance of adapting to local circumstances: partners perceived the style of integration as rigid. delivery of services became challenging in the latter months of 2004: rolling out an integrated service across all Scotland so rapidly at this time was over-ambitious. call back put the organisation into disequilibrium and compromised the whole episode of care.

  20. The challenges faced by NHS 24 during its roll out have clouded the achievement of setting up a national first point of contact for access to service out of hours: compare with other countries. • There are lessons to be learnt for the planning of new services: • ensure conditions for introduction of new services in place before launch, don’t assume these will be overcome during implementation. • the level of support that new services need should not be under-estimated. • development should progress at a careful pace

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