111 Integrated Urgent Care​


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In February 2019, the new NHS 111 Integrated Urgent Care (IUC) service launched in south east London.
 
Provided by the London Ambulance Service, the new service will improve access for those who dial 111. Available 24 hours a day, the service will provide a new Clinical Assessment Service comprised of GPs, pharmacists and nurses who will provide clinical consultations to residents across South East London. The service can provide patient information, issue prescriptions to a pharmacy of choice, book a GP appointment, and, if necessary, refer people to emergency services. Even when a GP practice is closed, residents will be able to access this service and will be directed to NHS 111 and 111 online.
 
Patients across south east London have informed and influenced this new service. Two patient engagement events were held in 2015/16 and a survey was sent out to local people across south east London. Feedback was used to inform the development of the specification for the service which was approved by the south east London CCGs.  
 
After March 2016, an information pack detailing the response to the patient feedback received – in the form of ‘you said, we did’ – and the more recent developments to the IUC design, was produced and shared with local people. Additionally, patient groups were identified for further targeted engagement. These groups were identified on the basis of those who had access issues (deaf or hard of hearing; patients for whom English is not their first language; patients with learning disabilities) and groups that the equality impact analysis had highlighted as not having been engaged with so far such as people from the LGBT community.
 
Each CCG was asked to choose one of the patient groups and facilitate engagement with that group. Where possible, this was through the programme team attending an existing patient engagement meeting or convening a meeting for this express purpose. Where this was not possible, information was sent to relevant organisations that liaised with their service users and responded on their behalf. The following activity was undertaken:
  • Information sent to Bromley Deaf Access group; the response received included the importance of providing advice relating to staff training, promotion of the service, and the use of deaf friendly language.
  • Engagement session held with a Vietnamese group in Lewisham – 9 out of the 10 attendees had never heard of 111 before. Discussions explored the differences between 111 and 999, the translation service available through 111, the redesign of 111 and the best ways to promote the service to the Vietnamese community. The current service and the new design were both very well received.
  • Information sent to a KeyRing who supported Speaking Up – Southwark (a group for people with learning disabilities) to get their views on the new design for 111. The response indicated that current members of Speaking Up had not used the 111 service because they hadn’t needed to but they were aware of it and would use it if they needed to.
  • Information sent to Metro (a SEL wide LGBT group); the response received included the importance of providing advice relating to staff training, promotion of the service, monitoring LGBT usage and links to voluntary sector services.
  • Engagement session with Our Healthier South east London  Patient and Public Advisory Group – there were three people who attended who were knowledgeable about 111. There was a very detailed discussion about the current service and the proposed changes. The group approved of the proposed changes. Two members were recruited to the SEL 111 Programme Board and IUC Procurement Evaluation Panel.
 
All of the feedback received was incorporated into the revised service specification.
 
Two patients are now permanent members of our programme board. They sat on the SEL IUC Procurement Evaluation Panel and contributed to the scoring of the written bids and the scoring of the bidders at the Objective Structure Clinical Examination (OSCE) day. They also took part in workshops to finalise the questions used in the procurement process.  Training was provided to enable them to fully contribute to the procurement process.  
 
During the mobilisation of the new service, the patients have sat on the SEL IUC Mobilisation Programme Board, the Alliance Leadership Team (responsible for building relationships between 111, the GP out of hours services and GP federations), the Clinical Advisory Group (responsible for agreeing patient pathways, standard operating procedures and clinical profiling of services on the Directory of Services) and the Communications and Engagement Group (responsible for informing stakeholders about the changing service).

The patient representatives will remain on our programme board as we move into the benefits realisation stage of the project. One of the patient representatives is also a permanent member of the SEL IUC Clinical Governance Group.

The patient representatives, Paul Brown and Moh Okrekson, said: “We have served as public and patient voices on the 111 Programme Board (since re-designated the Integrated Urgent Care Programme Board) in our capacity as members of the Our Healthier South East London Public and Patient Advisory Committee. 

"We were fully involved in the development of the new enhanced NHS 111 integrated urgent care service (IUC) for SE London and in the procurement which awarded the contract to the London Ambulance Service. Since then, we have continued to be involved in the mobilisation of the new service.  We have been impressed with the transparency of the process and the willingness of clinicians and managers involved to answer our questions and take our views into account.  We have felt part of the team. 

"We hope and believe that the IUC service now launched will see many more patients given health advice by clinicians or booked directly into an appropriate NHS service. It will serve patients better and ensure that people get the right care at the right place for their needs and therefore make better use of resources."