It is really important to us that members of the public – who could become our patients at any time – know how our service operates and understand how it mirrors the care that they receive ‘in hours’ at their local surgery.
What service is provided?
Integrated Care 24 is a not for profit social enterprise, so any surpluses we make are reinvested straight back into the organisation. The service that we provide is for people who have urgent primary care needs when their local surgery is closed.
This means that we offer a similar service to that which patients would receive at their own GP surgery, but our service is accessed via the NHS 111 service when GP surgeries are closed. i.e evenings and overnight during the week, 24 hours a day at weekends and Bank Holidays.
Demand for our services fluctuates. Weekends and Bank Holidays are our busiest times, but during the overnight period our patient numbers significantly taper off, and we adjust our staffing according to that to ensure that we make best use of our resources.
Our service is commissioned by local clinical commissioning groups (CCGs). We work closely with our CCGs and set our rotas with their agreement. Staffing levels are based on data relating to the demand that we expect to see within our services.
Our clinical and non-clinical staff support thousands of patients each year and our patient satisfaction results are positive. In each month of 2018 at least 90% of patients across the organisation were either satisfied or very satisfied with the service they received.
In November we scored 92.42%, and in December 92.89%. We accept that we won’t get it right every time, but we take feedback on our services seriously and are committed to learning and improving. Further down we have included some statistics that show the levels of demand that our service deals with.
Workforce and model of care
At IC24 we follow the national approach to delivering face to face urgent primary care.
The previous model of 'out of hours' care was entirely focused on GPs delivering the service. However, shortages in the GP workforce nationally are well known and continue to be a much-discussed topic.
Our staffing model consists of a team of multidisciplinary clinicians competent in delivering urgent primary care, led by GPs, and including Advance Nurse Practitioners (ANPs) and Urgent Care Practitioners (UCPs). The urgent care workforce mirrors the changes that have also been made in the modern in-hours primary care workforce of GPs, ANPs and UCPs.
Just last week, plans for a new five-year GP contract deal were unveiled, which included plans to fund 20,000 non-GP staff within primary care networks, which will help make better use of key highly skilled professions such as pharmacists and paramedics.
As per the national direction, we operate a clinical assessment service within our NHS 111 services to provide early clinical oversight of patients. We do this to try and complete the call for the patient at the earliest, safest and most convenient point in their contact with us. However, if the patient needs face to face treatment they can either visit us at one of our out of hours bases or – if the clinical need demands it – receive a home visit.
If a patient presents with a condition that is more serious than would be seen in an urgent primary care setting we can refer them from NHS 111 to their local Emergency Department or, if in an emergency, we can dispatch an ambulance to the patient.
We know that the NHS Pathways system can be risk averse at times, so early clinical intervention ensures that patients do not have to attend a face to face appointment with us when we could have resolved their issue over the telephone. IC24, along with other 111 providers, have been developing clinical assessment services in partnership with other health services such as the mental health and community services.
Staffing forms a key part of our planning, and we closely monitor demand for our services and our staffing levels are set to reflect the demand that we expect to see.
When a patient contacts our service it is our job to ensure that, just like during the in-hours period, the patient is seen by the right healthcare professional to meet their needs. We have a team whose sole job is to produce our rotas, focusing particularly on critical shifts where we see the greatest demand.
Like any other organisation, our rotas sometimes change unexpectedly on the day due to factors such as sickness and this is monitored closely by operational managers, who will move resources according to demand.
The NHS 111 service nationally received over 1.6 million calls during December 2018. The following statistics give a snapshot of our services across all of the localities we serve in December 2018:
- Number of NHS 111 calls received – 107,877
- Percentage of those calls answered within 60 seconds – 86.5%
Out of hours:
- Face to face activity (Base appointments and home visits) – 39,155
- Advice calls – 28,131
Christmas and New Year
The Christmas and New Year period is a very busy time of the year for all healthcare services, and we are no different. Below is a brief snapshot of the demand on our service between 22 December and 1 January:
- NHS 111 calls received – 47,468
- Percentage of those calls answered within 60 seconds – 81.4%
Out of hours
- Face to face activity – 11,385
- Advice calls – 12,262
In the year of 2018 we dealt with 644,233 cases in our out of hours services. The percentage split between telephone advice, base appointments and visits is around 43/45/9, and just under 2% of patients who are classified as ‘walk in’ patients. That is to say, those who have not been directed to the service via NHS 111.
We are committed to working with other healthcare providers and stakeholders to deliver the national model of integrated urgent care. Our services are registered with an inspected by the Care Quality Commission and we work closely with the CCGs who have commissioned us to ensure that we are delivering the best possible service to our patients.
We are also committed to supporting and developing our staff to make sure that we recruit and retain the best healthcare talent, for the benefit of our patients.