NHS 111 First: Contact 111 before visiting A&E

From Wednesday 11 November, people in Morecambe Bay who need urgent NHS care are being asked to contact NHS 111 either online (visit 111.nhs.uk) or by phone (dial 111) before they decide to walk in to the Emergency Department (A&E).

To avoid long waiting times in Emergency Departments, people who do not need an ambulance are being asked to contact NHS 111 First for an appointment before attending. The service will then book them a time slot at the most appropriate health service for the patient, which may include Royal Lancaster Infirmary, Furness General Hospital, an Urgent Treatment Centre, or an out of hours service.

The timed slots will also help with social distancing in the Emergency Department waiting areas and therefore help to prevent the spread of coronavirus during the pandemic.

The new approach will ensure that patients can access the clinical service they need, first time. Patients who need to be seen in the Emergency Department will be able to be seen and treated quicker.

Morecambe Bay follows on from other regions in the North West that have already implemented the new nation-wide system. Fylde Coast was the first region to implement the system, followed by Pennine (East Lancashire). NHS 111 First is being rolled out nationally by December.

Dr Jim Hacking, GP Executive Lead for Urgent Care at Morecambe Bay Clinical Commissioning Group, said: “This is about improving our offer to patients by helping them to access the right service quickly while also keeping them safe in a COVID-19 world, when we need to carefully manage the numbers of people in our Emergency Department.”

“People who need emergency care should still call 999 straight away. Those people who are not in serious danger but need urgent attention should now contact NHS 111 First either by telephone or online.

“They will be spoken to by a trained professional and a clinician if needed. If it is decided they should go to the Emergency Department then they will be given a suitable time to attend and staff at the hospital will be expecting them. The added bonus is that the staff in the Emergency Department won’t have to do any further triaging or initial assessments as that will already have been done by NHS 111. This means the patient will be seen and treated faster.”

Nationally around 70 per cent of people attending Emergency Departments had just walked in and the majority of those could have been seen through other services, such as the Urgent Treatment Centres, GP or even pharmacy. In the last few months in Morecambe Bay, around 69 per cent of attendances to the Emergency Department were people walking in unannounced.

For those living in rural areas the change could prevent unnecessary trips to hospital as there may be cases where treatment can be offered nearer to home.

Anyone who attends the Emergency Department without an appointment from NHS 111 will still be seen but could be directed to other services for treatment. Those with appointments from NHS 111 will also be given priority unless there is a medical need.

People with life threatening conditions that need emergency attention should still call 999. There is no change to the way in which people should seek advice from their pharmacy or make an appointment with their GP if their condition is not serious.

 

Easy read video: NHS 111 First

This easy read video explains why should you contact NHS 111 first if you need help for something that’s urgent but not serious or life-threatening.

https://www.youtube.com/watch?v=jl6Kb24-F58&feature=youtu.be.

 

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Frequently Asked Questions (FAQs)

When can NHS 111 be accessed and how?

When can NHS 111 be accessed and how?

NHS 111 is available 24 hours a day, 7 days a week – from wherever you are within the North West and nationally. 

To get help from NHS 111, you can:

  • Go to 111.nhs.uk (for people aged 5 and over only).
  • Dial 111 for free from a landline or mobile phone (all ages).

What is 111 First?

What is 111 First?

111 First is a national programme that aims to get people to contact NHS 111, whether online or by phone, if they think they need to attend an Emergency Department (ED/A&E) to treat an urgent, but not serious or life-threatening, medical need.

The new system reflects new safety measures for seeing patients in EDs and other treatment centres because of the pandemic, preventing the spread of infection by preserving social-distancing, and segregating people with and without COVID-19.

In the North West NHS 111, as provided by NWAS, is already able to book appointments for patients at a number of healthcare services, including GPs, and this is being expanded to include EDs/A&Es and urgent treatment centres. 

Currently patients located in Morecambe Bay and who are assessed as needing to attend an ED, will be advised to attend the ED for treatment and a timeslot will be booked for them. This service will be live in all North West areas by December.

What are the benefits of calling 111 First?

What are the benefits of calling 111 First?

  • People will only need to make one call in order to be seen at the most appropriate service for their needs, in a time appropriate manner.
  • If someone contacting NHS 111 needs urgent or emergency face-to-face assessment or treatment, this can be arranged there and then, without any further delay. Patients will know exactly where to go, and when. This will help also reduce waiting times for all patients
  • By advising people where and when to go, queues/crowding in ED/A&E waiting rooms can be controlled and the risk of COVID-19 transmission significantly reduced.

Do clinicians work for NHS 111?

Do clinicians work for NHS 111?

Yes. Clinicians play an important role in our NHS 111 service. We employ a number of clinicians, many with a wealth of clinical knowledge and backgrounds in nursing and emergency responding.

Whilst on the whole our NHS 111 health advisors are the people you are most likely to speak to when you first make a 111 call in the North West, it may be deemed appropriate that you will need a call back from one of our experienced clinical team. Our clinicians provide call backs to patients based on a clinical queue system that prioritises those most in need of help first.

When receiving a clinical call back the clinician will undertake a validation of the assessment already completed when the patient first rang – this may seem like many of the same questions but it is important for our team to check if details are correct, if anything has changed or has got better or worse, and they have the knowledge to ask more in-depth questions to make sure we have the full picture on symptoms.

Our service can access any notes on a patient’s file if they are shared with us, which may help us with a diagnosis, whether this is information of a care plan or pre-existing medical condition, which means that NHS 111 can deliver the best and most efficient care possible. 

Will NHS 111 be able to cope with the extra calls?

Will NHS 111 be able to cope with the extra calls?

To support the service and to deal with any increased pressure as we go into the winter period, capacity in the 111 service has been expanded significantly. This means that more trained health advisors and clinical advisors than ever before will be available to respond to the health needs of our patients.

Currently around 335 health advisors and 65 clinical advisors look after the North West 24/7 365 days of the year – and this number will be expanded to 389 health advisors and 103 clinical advisors, in the first instance. Further recruitment is planned for the New Year.

How does this ease pressure on other services?

How does this ease pressure on other services?

In many cases NHS 111 clinicians and health and service advisors can give patients the advice they need without using another service such as ED (or A&E).

NHS 111 health advisors in the North West undertake an assessment with the patient, using the NHS and clinically approved NHS Pathways triaging tool. They ask patients questions on their symptoms to determine the most appropriate care for their needs. This may be their GP, out of hours GP, pharmacist, walk in centre, urgent treatment centre, ED or even a 999 emergency response. Encouraging people to ring 111 before they turn up at ED for less urgent medical needs may mean that the patient is seen in a different, but more appropriate setting than ED. Spreading people out around appropriate health care services leaves those most in need of urgent and emergency help the access to these services.

By reducing the numbers of patients attending ED, 111 First relieves pressure on busy departments and reduces the risk of COVID-19 transmissions in waiting areas where social distancing will be difficult to maintain and manage. 

How long will it take to ring 111 and will patients need to repeat information over and over again?

How long will it take to ring 111 and will patients need to repeat information over and over again?

Last year, NHS 111 in the North West dealt with over 1.5 million calls, with the average call being resolved in around nine minutes from being answered.  

In some cases NHS 111 clinicians will need to ring the patient back to further assess their symptoms, this will be to determine the best place to provide care or to give self-care advice for patients to safely look after themselves at home.

The clinician will go over the responses that were given in the initial assessment to validate the answers and to use their clinical knowledge to further investigate symptoms.

111 records all the information given on a call and this is sent electronically to the receiving service, this means the patient doesn’t have to repeat themselves but the information is clarified and validated.

Patients are given advice that if their conditions worsen they are to call back and another assessment will be completed to ensure they are advised to see the most appropriate service. There are also processes in place to identify frequent callers to the service, such as alerts to GPs, which means we can assess on going needs of patients.

Isn’t NHS 111 just an information line?

Isn’t NHS 111 just an information line?

No – NHS 111 is much more than information line. NHS 111 helps to get the patient to the right service for their clinical needs first time.

NHS 111 can make direct appointments at GP surgeries and urgent treatment centres - as well as send an ambulance should the patient’s condition be serious or life-threatening.

With the roll-out of NHS 111 First, people contacting 111 who are assessed as needing to attend an ED, will be advised where they need to go for treatment and a timeslot will be booked for them. This will drastically reduce the time typically spent queuing in waiting rooms.

Blackpool and Warrington were the first EDs to go live but this will be rolled out to more sites over the winter months, with the aim that the whole of the North West, and country, will be complete by 1 December. 

Are call handlers trained and is it safe to follow a script?

Are call handlers trained and is it safe to follow a script?

Our NHS 111 health advisors undertake a rigorous 10-week induction programme. What they say and the questions they ask have been developed to ensure patients get the right care, using a clinically and NHS approved system called NHS Pathways. This system is regularly updated and reviewed by clinical experts including representatives of the medical Royal Colleges.

A multidisciplinary team of clinicians (including nurses, paramedics) also oversee 111 calls, providing guidance and taking over the call if a patient has more complex needs. Their service also has access to specialist clinicians such as mental health clinicians and pharmacists.

The NHS Pathways system is set up to ask appropriate questions to rule out the most serious conditions first. The system is able to identify situations where the patient’s symptoms are considered serious, life-threatening or in need of emergency treatment and electronically transfer their details directly to the 999 service for an emergency response.

Can NHS 111 book into all of the North West’s Emergency Departments (ED)?

Can NHS 111 book into all of the North West’s Emergency Departments (ED)?

Blackpool and Warrington were the first EDs to go live but this will be rolled out to more sites over the winter months, with the aim that the whole of the North West, and country, will be complete by 1 December. Morecambe Bay is now live, which means that NHS 111 can book an appointment into the Royal Lancaster Infirmary or Furness General Hospital.

Is NHS 111 only for physical health problems?

Is NHS 111 only for physical health problems?

No - callers in mental health crisis who call 111 are assessed with the same care as callers with physical symptoms. Once assessed, callers can be transferred to local mental health crisis services, if available in their area, to ensure they receive timely specialist mental health support. 

What if a patient turns up to an emergency department (ED/A&E) without a booked slot?

What if a patient turns up to an emergency department (ED/A&E) without a booked slot?

If people do make their own way to EDs/A&Es and UTCs, they will continue to be seen. Patients needing emergency treatment will be prioritised, however those whose conditions are not as urgent may need to wait elsewhere. In some cases, they may be directed to alternative local services if this would be safe. Using 111 first will ensure that patients get quicker, safer care in the right environment and will help us to better control the risk of the virus spreading. Those in need of the most urgent and emergency care will be seen first.  

When should people call 999 or what if they are unsure if their symptoms are serious or life-threatening?

When should people call 999 or what if they are unsure if their symptoms are serious or life-threatening?

Arrangements will not change for people with serious or life-threatening illnesses or injuries, who should continue to dial 999 as before.

If someone is not sure what to do, they should call 111 and a fully trained health advisor can assess their symptoms and arrange contact from a healthcare professional or dispatch an ambulance if needed.

How can NHS 111 First help those who struggle with communication or hearing, or do not have English as their first language?

How can NHS 111 First help those who struggle with communication or hearing, or do not have English as their first language?

All 111 providers follow The Accessible Information Standard, meaning that people who have a disability, impairment or sensory loss get information they can understand and any communication support they need.

For those who have difficulties communicating or hearing, they can:

  • tell the call handler that they need an interpreter
  • call 18001 111 on a text phone or using the Next Generation Text (NGT) Lite app on their smartphone, tablet or computer; or
  • use the NHS 111 British Sign Language (BSL) interpreter service if they’re deaf and want to use the phone service.

Who was involved in deciding what changes needed to be made in the North West?

Who was involved in deciding what changes needed to be made in the North West?

Our approach has been developed by a range of specialists including hospital consultants, GPs, nurses, paramedics, pharmacists, social workers, mental health specialists, and NHS 111 teams using local knowledge and expertise. This approach is similar to that being used across the rest of the country but we have also spoken with a number of people from across the region to get their views and considered their feedback as part of the design process, ensuring the approach works for us.