Bulletin 04.06.2013

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Bulletin 04.06.2013

111 Repeat Callers

The national service specification for handling repeat callers (i.e. patients who call NHS 111 three times in four days) states that these patients should receive an assessment from a GP within one hour.

The GPC and NHS England reached an agreement that GPs are neither contractually obliged nor indemnified to make call backs and assess these patients within one hour and they have agreed the following joint statement:

NHS 111 commissioners and providers have a responsibility to ensure that repeat callers (those who have called the NHS 111 service 3 or more times in 4 days and, because of the potential risk, require a thorough senior clinical re-assessment by a GP within the hour) receive the service as specified.

There is no national mandate as to how this service should be provided or resourced, nor is there a contractual obligation for practices to do this work. However, it is the responsibility of CCGs as the local commissioners of NHS 111 to ensure an appropriate service is commissioned. If local GPs are not satisfied with the current local arrangements for dealing with repeat callers, then commissioners and providers should work to find another solution.

Cleveland LMC has been involved in lengthy discussions with the 111 team to try and find a local solution to this problem that is as safe as possible for patients and all GP practices. The simple fact is that it is not contractual for anyone to do this, including GPs, 111 or any other provider. This is an inherent problem of the system that has been created nationally then passed for local solution with no guidance other than nobody is contractually obliged to deal with this pathway but this pathway will still continue to exist!

We are not happy that the ‘your GP will call you back within one hour’ element is to continue within 111 for repeat callers. However, we have compromised with a solution that will offer a safety net to practices and patients whereby, when a GP is not able to contact the patient within 1 hour (be it due to capacity, GP is unavailable, patient is unavailable, triage deems it inappropriate or you are simply not contractually obliged to do so) the patient is advised to return to 111 who will direct them to a walk-in centre to see a GP.

Hopefully this safety net will catch any patients who GPs have not been able to contact in the hour and, to a degree, puts the onus back on the patient to notify 111.

Below is the new system that is now in place for repeat caller:

  • 111 disposition tells the patient that their GP practice will call them back in 1 hour but if they have not heard back within 1 hour the patient should call 111 again
  • 111 make call to GP practice to try to speak to a clinician to provide details of repeat caller and a) pass on details directly to a clinician or b) pass on details to the receptionist. At this point responsibility is passed to the GP practice and the practice should deal with this as they see appropriate e.g. call within the hour or not dependent on capacity, triaging, other factors
  • If the GP has not called the patient with 1 hour the onus returns to the patient and when the patient does call 111 they will be advised that they should attend the nearest walk in – details given – to see a GP

As explained earlier, practices are not contractually obliged contact patients within 1 hour but responsibility will still be passed to practice by 111 and you need to triage appropriately – as you would any urgent call to the practice. It is anticipated that practices should on expect a couple of repeat callers per year.

Everyone involved accepts that this solution is far from ideal but given the constraints of contracts, budgets and a nationally produced specification it is the safest and best practical solution that can be put in place within a tight timescale as, since 111 went live in April, there has been no safety net for patients or practices and potential for a serious untoward incident. We will closely monitor the number of repeat callers and the outcome of this element of 111 and we will continue to work with 111/CCG to find a longer term solution to this ‘specification v contract’ issue. It is imperative that something is put in place so that there is a contracted/resourced solution with a provider for this element and we are urging CCGs to look closely at the contracts of providers in the new commissioning round to resolve this nationally created problem.

If you have any question on this element of 111 please do not hesitate to contact Janice.foster@tees.nhs.uk

Interim Seniority Payments
The Health and Social Care Information Centre has published the interim seniority factors 2013/14 for GMS GPs in England, Wales and Northern Ireland today.  The figures are: England £96,183, Wales £84,479 and Northern Ireland £82,176. Further information about the calculations and the methodology may be seen on the primary care section of the Health and Social Care Information Centre website.

CQRS Phase 2 Training
Please see attached information regarding phase two training sessions for CQRS. We strongly recommend that ALL practices ensure they attend the phase two training sessions for CQRS as much of the practice funding streams will rely on timely and accurate completion of CQRS data by the practice. In summary:

  • CQRS will go live early June (replacing QMAS).
  • GP practices may find it useful to undertake phase two training to learn how CQRS works and what is required to ensure that practices continue to receive accurate payments throughout the financial year.
  • Phase two training sessions will run from the 29 May to the 26 June and are bookable via the CQRS Learning Management System (LMS).
  • To book onto phase two CQRS training GP practices will need to be registered onto the LMS and have access to an N3 connection. To register and book on the LMS, please read the details on the how to book onto a training session page.
  • QMAS will remain operational until the 31 July 2013 to allow for end-of-year activities for the QOF for 2012/13. On 2 July 2013, at 8pm, all submissions to QMAS from GP system suppliers and any manual updates or adjustments will be suspended. From this date QMAS will only be available in ‘view only’ mode for all users until 31 July 2013.
  • Existing data from QMAS will be migrated to CQRS, giving users on going access to their QOF reports from previous years.

GP Central Data Base Patient Opt Out
The care.data service is a new project that is designed to link information from general practice, with information from hospitals and community health care services. It is not the same as the national spine and if patients wish to opt out they have to do so again. It is hoped the project will help the NHS evaluate and improve the quality and safety of the NHS, and enables patients to make more informed choices about the treatments and services they use. The relevant READ CODES are contained in the information sheet and the associated FAQs, developed in partnership with the British Medical Association and Royal College of General Practitioners. Further information is available on the NHS England website and explains the process of how data from general practice will be collected, anonymised and used to improve patient care. The posters and leaflets are not yet available and we understand that GP practices will be contacted directly with further details and materials in June.

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