Having identified gaps in the provision of NHS 111 appointments from GP practices, Coventry & Warwickshire ICB and Integrated Primary Care’s Digital Champions have worked together with practice colleagues to understand the problem and reach full compliance.
The challenge:
As commissioner, Coventry & Warwickshire ICB oversees the contractual requirement for general practice to provide one NHS 111 appointment for every 3,000 registered patients. A dashboard report flagged 28 practices as non-compliant, with no slots available.
Instead of adopting the traditional approach of contacting practices to discuss contract performance, the ICB reached out to IPC’s Digital Champions for assistance. Our Digital Champions team is trusted by practices and PCNs to help them with digital or clinical system issues. Utilising the team’s skills and established way of working directly with practices made them a logical first step to help resolve the issue.
Our approach:
Initial conversations with the ICB enabled us to identify several contributing factors affecting 111 appointment slot availability, including:
- Multiple data sources, each with a different perspective on the issue, which did little to identify the root cause
- Guidance given to practices had not been consistently communicated or understood
- The recent change in NHS 111 provider which had not been comprehensively understood
- Contractual interpretation regarding appointment slot availability was variable
- Engagement with the new NHS 111 provider, DHU, was limited
In most cases, practices thought they were compliant and offering slots. However, the set up and visibility of those slots did not make them outwardly visible to DHU.
Our Digital Champions team identified that the data sources were inconsistent. We contacted all 28 practices that had been flagged on the dashboard, providing instructions on correct settings mapping, and ensuring affected practices understood the requirement. Often it was as simple as an email exchange to outline the changes needed, as practices are very proficient in updating their clinical system.
Where needed, we visited sites or held a Teams call with practices to go through the steps required to re-map the appointments for external visibility.
We also contacted DHU who were very helpful and showed us what slot availability they could see and how they approached a booking when they had a caller on the line. This valuable insight showed the errors they were seeing were different from the issues practices and the ICB had thought were the issue.
We also worked with an NHS England team to understand setup difficulties that can lead to these appointment slots not being visible.
Outcomes
Within eight weeks, all 28 practices became fully compliant with NHS 111 appointment slots available.
Through effective working with the ICB, practices and the 111 provider, we were able to implement several interventions, including:
- Helping practices change their slot type to make it externally visible (GP Connect).
- Ensuring the new provider code was correctly mapped in the practice EMIS system.
- Ensuring a correct session holder GP was the slot owner.
- Liaising with GP Connect so they re-enabled services at their end.
- Changing the available slot template to ensure slot visibility.
We also articulated the contract requirement and worked with practices to enable the correct number of slots based on list size.
To improve understanding and effective working between the 111 provider and practices, we:
- Discussed the DHU operational ‘sweet spot’ for slot availability and potential alignment with practice workflow.
- Gave clear and consistent guidance on how to re-purpose slots if unlikely to be used.
- Acted as a liaison between practice and DHU to discuss practice specific anomalies (branch practices)
- Shared valuable insight into online triage enablement and the impact it has had on workflow and the need for 111
- We have also been given regular data and a key contact at DHU so we can understand their visibility of slots across the system, showing their willingness to collaborate and resolve this issue.
No contract breach discussions took place because of this work and the LMC as endorsed that the Digital Champions played a pivotal role in resolving this issue.
Our team has also built good relationships with the DHU and NHSE teams, enabling us to better understand some of the operational flows they have in place with practices to ensure they can book patients effectively.
Continuous support
We continue to actively monitor slot availability to ensure appropriate access to appointments for patients through the 111 service.
We have created to a ‘how to’ guide that will act as the manual for practices to manage this process going forward.
We continue to discuss with all external parties what we need to do and how to ensure consistency in interpreting the data used to review and measure the slots.
