Commissioning Services

The combined use of NHS Pathways and the Directory of Services can provide commissioners with information about the demand and supply of health care skills and services in their area. Whilst NHS Pathways provides the clinical assessment, the Directory of Services holds a comprehensive list of available primary care services available that can be used to refer patients into.

The Directory of Services, which allows the call handler to refer a patient to a service maintains a record of where the demand is from patients. Commissioners can download reports to assess and evaluate which services are being used regularly and where there are further demands.

The regular report can be broken down to show which clinical skills were searched for and which services have been accessed and referred into by time of day and location. This allows a more informed decision to be made about available services, opening hours, clinical skill sets and medical staff required to meet demands. For example, if the reports are showing a nil return for a service this would enable commissioners to make informed decisions on where to provide more appropriate care to patients with urgent care needs and ensuring budgets are used in the most cost effective manner.

So how does it work?

Let's take two patients, Mr Smith and Mr Jones they are both:

Similar in age,
Have the same medical need,
Live in the NG area, but are covered by two different primary care trusts for care
Call 999, which is covered by the same Ambulance Trust.

Commissioning Services example
(Hypothetical situation)

Both Mr Jones and Mr Smith dial 999 with the problem, a blocked catheter. The call takers assess both Mr Jones and Mr Smith using NHS Pathways. The clinical assessment via NHS Pathways identifies that both patients need someone that can unblock their catheter in the next two hours.

Although both patients have been assessed using NHS Pathways and the clinical skill set required for treatment are the same, Mr Smith and Mr Jones live in different postcodes and due to the available services in their areas the delivery of treatment is very different.

Mr. Smith

A district nurse, with the clinical skills needed to unblock a catheter is identified on the Directory of Services and is available to conduct a home visit, in the required timeframe. Mr Smith gets his catheter unblocked, at home, within two hours.

Mr. Jones

Although the clinical assessment identified that both patients needed the same clinical service, the search on the Directory of Services reveals that there is no service in primary care at midnight to deliver the skills Mr. Jones needs, so he receives a non-urgent ambulance to take him to the Accident and Emergency (A&E) department, in the early hours of the morning.

This information is very valuable to commissioners who can use this data as it provides a clear gap analysis, showing the clinical skills required by postcode and time of day. This will assist commissioners to identify when and where particular services are required.

By placing NHS Pathways as the clinical filter for all calls to urgent and emergency care and the Directory of Services to allow referral into primary care services, commissioners can ensure:

Consistent assessment at any point of telephone access.
Comparability of performance of any commissioned call handling organisations.
Consistent up-to-date data on specific demand by individual clinical skills, post code and time of day. This enables a clear view of usage and gaps across any given area.
Cross-referral of patients to the most appropriate service provider, regardless of the number called.