It is widely accepted that the current arrangements for Out of Hours care are inefficient, disjointed and in need of change. The arrangements are also confusing for the public who have to choose from an array of services when they perceive they have a health problem - should they use NHS111, Minor Injury Units, Walk in Centres, A&E or even try to get an 'improved access' appointment with a local GP service? It high time for an overhaul.

NHS England has decided Out of Hours care and also access to Urgent care services in general, needs to be improved across the country. To that end a national specification was drawn up last  year  ( ) that all CCGs are now required to implement by February 2019. This specification has been developed with input from national GP clinical lead, Dr Helen Thomas.

The purpose of this communication is to give you some basic information about the proposed new model and timescales and also to ask for some feedback through completion of the linked Survey Monkey.

The overall aim of the new arrangements will be to set up simplified access for patients who have a perceived urgent health need. The core plan will includes bringing together the NHS111 service and the OOH service to form a Clinical Assessment (diagnosis and advice) Service (CAS) that will enable calls from patients to be completed in the same call - no longer being asked to wait for a call back which prolongs patients' worry and adds to poor outcomes. This means bringing together more clinical input at the CAS to deal with clinical problems that need medical decision making. The service would still provide home visits and treatment centre base assessments for appropriate patients.
But the new model doesn't stop there. Not only will new clinical decision making protocols be used (replacing the current rigid Pathways software) but there would be new On-Line access to advice for patients. Over time the plan is to bring into the CAS service access to other health and care professionals - Pharmacists, Dentists, mental health workers, health advisors, social workers etc to enable all possible enquiries to be dealt with as immediately as possible, minimising delays and ensuring the patient is put into contact with the most appropriate professional first time.

Under the umbrella of Integrated Urgent Care (IUC) the aspiration is for the new model to be able to deal with requests for all non-emergency but urgent care. The integration will be with SWAST ambulance services, primary care, Somerset Partnership's community services as well as mental health, end of life and social care services.

It would be hard not to argue against the aims and principles of the new model of service but with the proposed new arrangements come other issues that need to be considered. Not least will be the intention to improve urgent medical care provision In hours as well as Out of hours. There is currently a wide variation in the standards of medical care being prided in primary care in Somerset which effectively means a postcode lottery as to whether you can get consistent access to the highest possible quality of urgent care. This will be looked at to be improved. There is also the opportunity that the model, over a period of time, could evolve to manage a lot, if not all, on the day demand for primary care services – regarded by many GPs as the number one factor making their job most stressful. This transfer could allow some GPs to continue to provide urgent care by working at properly equipped centres and allow others to remain providing the routine care for the key aspect of primary care continuity.
Clearly this is only being discussed in principle in Somerset at present but there are other areas in the country where CAS's have already been established effectively who are looking at making the changes described above to deliver urgent primary care. How this will affect GMS/PMS contracts and funding flows etc remains to be seen. Similarly any significant service changes would need formal consultation with the public which would be essential if any major changes to the arrangements of urgent care in hours were to be progressed.

As to what is happening now in Somerset, a Procurement Project Board (PPB) has been set up to oversee the process of advertising the new model CAS/IUS specification, receiving tenders and evaluating these to ensure Somerset delivers a safe, affordable, fit for purpose new model of Out of Hours care as the first stage in the process of improving and integrating urgent care services.

The timetable set to meet the deadline of February 2019 is to agree the specification and send out to interested bidders by the end of April. On receipt these will be evaluated and a recommendation made to the Board with the announcement of a preferred bidder at the end of June and an eventual contract award announcement by the Governing Body in July . It is a very tight timeframe and there is a lot of work to be done to get the desired result for Somerset. As with all CCGs in order to make this happen by the deadline of Feb 2019, the current provider of both NHS111 and OOH services, Totally Ltd. (formally Vocare) was served 12 months notice last month that these contracts would be ending.

Although the core specification (all 149 pages of it) is set by NHS England and sets the core model, national standards and performance indicators, there is scope for adapting to local need. The Procurement Project Board includes 2 GPs, Dr Will Harris and Dr Geoff Sharp and we are keen to ensure our GP colleagues are aware of what is going on around urgent care services and also to hear from as many of you as possible, through the survey, as to your thoughts and suggestions. 

We look forward to hearing from you.