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111: Evolution or Revolution?

20 February 2012 : Jean Challiner, Chief Medical Officer. The accelerated introduction of the NHS 111 programme, which is due for national roll out by April 2013, is provoking questions and opinions on the eve of the new service.

So far, the main discussion points have been around the potential increase of workload for GPs[1], the need for more active clinical engagement with the 111 service roll out amongst clinical commissioners[2], and the financial implications when managing patient demands for treatment[3].

Coping with call volumes

Success will bring its own challenges.... effective marketing of the memorable '111' number could lead to a rapid up-surge in call volumes that the new service will not have the capacity to handle.

These worries seem set to be realised as the new service beds in, given the planned forecast of 16 million calls in the first year of the service. Peak periods of demand as a result of health scares or just regular winter pressures will add further strain.

The anticipated immediate surge in calls can be managed effectively, but only if the supporting technology is designed and deployed appropriately.

It is imperative that providers ensure they have a fully resilient 111 infrastructure from the outset. This will provide the required security they need and ensure there will be almost no circumstances that result in reduced performance. This is critical given that the success of the initial service will see it extend to its full scope, which includes all non-urgent and social care calls generating between 3 and 10 times anticipated call volumes.

Business continuity and disaster recovery are also essential. Whilst the volume and the ubiquity of the service will grow and the dependency of the health services on 111 will increase, there will be no tolerance for downtime. Dedicated 24x7 managed services must be available to offer the responsiveness that is essential to support business delivery on a daily basis and during the most active periods, for example at night or during festive seasons.

In many regions, the predecessor services are currently based on small, shared infrastructure hubs, which allow them access to the National NHS Network (N3).

These hubs will not have the necessary resilience for NHS 111. Upgrading them will prove too expensive. If the new service is to succeed, it will have to be based on an infrastructure that has the track record of handling tens of millions of calls.

Clinical Solutions has set up this type of infrastructure for existing 111 pilots. Although each of the pilots is quite small in its own respect, they are all running on national scale IT infrastructure that has proven its scalability over the past 10 years for the national triage service. During the 2011 festive period the technology was used by over 1,250 simultaneous users in the UK and could therefore give plenty of headroom to any of the local services.

"Clinical Solutions technology has been specifically designed to meet the challenges of 111 head on. Our fully resilient N3 infrastructure has taken over 70 million calls and has been proven to cover up to 12,000 calls per hour from a single provider, with 30 per cent faster call handling for optimal triaging. In addition to this, Clinical Solutions' infrastructure guarantees 99.99 per cent uptime, meaning service providers can rest assured that calls from the public are handled as efficiently and effectively as possible, leading to the most appropriate, and cost-effective outcome."
Shaun Hopgood, Executive Vice President UKI & Operations

Tackling the cost of ownership

One of the key challenges for NHS 111 is the cost of call handling. However, when it comes to the economics of 111, whilst call handling time is the key priority for the service providers, for commissioners (and patients) the focus is on call sorting outcomes[4].

In addition to this, care providers are concerned about the associated costs of non-clinical call takers trying to deliver high quality health advice, as specified by the NHS 111 service; GPs are concerned that they will be left with an unnecessary increase in workload (and therefore costs) if inappropriate referrals are made to them or care advice given is inadequate[5].

The key to removing all these challenges is to have the right delivery model with optimised clinical content, such as TeleGuide 111 from Clinical Solutions. Technology can efficiently and cost-effectively support call handlers step by step through their part of the triage process. Clinicians can then validate the outcomes or complement the encounters when needed.

"Working with Clinical Solutions makes sense, based on the safety record and efficiency of TeleGuide 111 content within the IntefleCS 111 CRM. Calls are expected to be 30 per cent shorter than those reported in existing 111 pilots, while we are anticipating less than 4 per cent of calls to require an Ambulance dispatch, with well in excess of the reported 11 per cent from the existing 111 pilots of triaged calls going to health information or home care."
Dr Mark Norman, Chairman at Frendoc

hen it comes to delivery pricing, the largest risk for providers is to ensure that surge requirements are covered. Swings in call volumes can be multiplied by ten during a given year and herald large associated capital expenditures to sustain estimated peak demand. A non-onerous contract, such as one that can accommodate a price per call with no upfront investment, will enable the provider to concentrate on service introduction. For providers needing to move away from the local hubs to ensure resilience, this type of contract will also remove a serious cash hurdle if they want to deliver a successful 111 service.

NHS 111 is an ambitious endeavour. It is creating challenges for providers around unit pricing, interoperability and patient demand management. All these technical and process hurdles can, and will, continue to be addressed one by one as the service evolves. The real revolution of NHS 111 may well be its ability to cope with the scalability requirements of the service. These scalability demands can only be managed through the deployment of a proven and adapted infrastructure, which allows providers to easily introduce and deliver a successful local NHS 111 service from the outset.

[1] http://www.ehi.co.uk/news/EHI/7503/more-gp-leaders-raise-concerns-about-111

[2] http://www.ehi.co.uk/news/EHI/7548/bma-calls-for-nhs-111-slow-down

[3] http://www.ehi.co.uk/news/EHI/7548/bma-calls-for-nhs-111-slow-down

[4] http://www.clinicalsolutions.com/news/2012/66/new-clinical-solutions-111-content-set-to-save-nhs-111-200m.aspx

[5] http://www.clinicalsolutions.com/news/2012/67/frendoc-go-live-with-teleguide-111.aspx
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