You are here: Home → Services & Applications → NHS Pathways → The story so far
 

The story so far

NHS Pathways coverage map

View the coverage maps to see where NHS Pathways and the Directory of Services are being used to clinically assess and refer patients.

NHS Pathways and the Directory of Services are being used across various organisations. Please see the details below of how ambulance trusts, out-of-hours providers and NHS 111 are using it.

North West

NHS 111 was launched in Lancashire (excluding West Lancashire), North West using NHS Pathways assessment tool, in November 2011. Cumbria is due to go live in late February. NHS 111 in the North West is being delivered by Fylde Coast Medical Services and NHS Direct.

NHS London

London Central West (LCW) implemented NHS Pathways into their existing SPA service in December 2011. This services patients in Kensington and Chelsea, Westminster, and Hammersmith and Fulham.

As a provider of unscheduled care LCW provides out-of-hours primary care services to 800,000 patients across four primary care trusts, covering Brent, Hammersmith and Fulham, Kensington and Chelsea, and Westminster, offering GP telephone advice, GP surgery consultations and GP home visits.

LCW provides 24/7 clinical support, infrastructure and organisational support during in-hours including primary care A&E streaming/re-design models and two NHS led walk-in centres.

Harmoni, the largest provider of primary care services in the UK, also implemented NHS Pathways into their out-of-hours service in December 2011; this covers patients in the Hillingdon PCT area. In February 2012, Hillingdon became the first area in London to use NHS 111 to assess calls.

Harmoni has over 300 GP shareholders and provides care to over eight million patients in the UK. It delivers integrated care pathways through a variety of services including, out-of-hours services, Single Point of Access, 111 telephone services, GP led health centres and Urgent care centres.

West Midlands Ambulance Service

West Midlands Ambulance Service has gone live with NHS Pathways at two sites, Tollgate in July 2011 and Millennium Point in September.

The Trust serves a population of 5.36 million people which is around 10% of the English total. The area covered is a little over 5,000 square miles and is made up of Shropshire, Herefordshire, Worcestershire, Warwickshire, Staffordshire and the Birmingham, Solihull and Black Country conurbation.

Wiltshire Medical Services

Wiltshire Medical Services has been using NHS Pathways to assess their out-of-hours calls via their local single point of access number, since June 2011.

Wiltshire Medical Services is the sole provider of GP out-of-hours care in Wiltshire and serves a population of approximately 450,000 residents. They also provide an out-of-hours call handling and triage service for the population of Bath and North East Somerset, which is also covered by NHS Pathways.

South East Health Ltd

In May 2011, South East Health Ltd went live with NHS Pathways and the Directory of Services in the Warwickshire Healthline service. This Single Point of Access and GP out-of-hours pilot covers Kent and East Sussex areas.

South East Health Ltd is a not for profit primary care provider, formed from a number of out-of-hours co-operatives, has provided a full primary unscheduled care service across the South East for many years. They provide GP-led primary care out-of-hours services on behalf of seven primary care trusts, operate other schemes such as walk-in centres, GP-led Health Centres, out-of-hours district nursing and an innovative Roving GP service.

Isle of Wight Ambulance Service

In May 2011, the Isle of Wight Ambulance Service went live with NHS Pathways and the Directory of Services in their 999 control rooms.  Beacon Health Centre, which provides GP services to all residents on the island, also uses the clinical assessment tool to assess their out-of-hours patients, between 6.30pm and 8am. Those who do require an ambulance are referred to an available primary care service with the clinical skills needed for treatment, via the Directory of Services.

The Isle of Wight ambulance service is integrated with the Isle of Wight NHS Primary Care Trust, and is the only ambulance service in England with this unique status.

The resident population of the island is approximately 138,500 - this figure doubles in the holiday season with the island receiving approximately 2.8 million visitors each year.

After the successful go-live of NHS Pathways and the Directory of Services in the Isle of Wight, NHS 111 was implemented across the Island in October 2011.

The 111 service is free to call from landlines and mobiles, and is staffed by fully trained call advisers. The 111 service is used in GP out-of-hours and for holiday makers away from home.

South East Coast Ambulance Service NHS Trust

The South East Coast Ambulance Service (SECAmb) NHS Trust became the third ambulance service to implement NHS Pathways and the Directory of Services into their three 999 control rooms. In April 2011, the trust successfully went live with NHS Pathways and the Directory of Service in two of their three 999 control rooms. The third control room followed in mid May.

The Ambulance service is using NHS Pathways as their primary triage tool to assess 999 calls. The integrated Directory of Services is working with NHS Pathways to provide call handlers with details of available primary care services that can provide the specific clinical skills needed by an individual patient. SECAmb are also using NHS Pathways and the Directory of Services for GP urgent calls.

The South East Coast Ambulance Service covers a diverse geographical area of 3,500 square miles (Brighton & Hove, East Sussex, West Sussex, Kent, Surrey, and North East Hampshire) which includes densely populated urban areas, sparsely populated rural areas and some of the busiest stretches of motorway in the country.

South Western Ambulance Service NHS Trust

The South Western Ambulance Service NHS Trust (SWAST) became the second ambulance service in England to go-live with NHS Pathways and the Directory of Services in March 2011.

SWAST are using NHS Pathways as their primary triage tool to assess 999 calls coming into their control rooms. The integrated Directory of Services is working with NHS Pathways to provide call handlers with details of available primary care services, which can provide the specific clinical skills needed by an individual patient. SWAST are also using NHS Pathways and the Directory of Services for GP urgent calls.

South West Urgent care service, which provides out-of-hours services for Dorset and Somerset went live in January 2012. They will be using NHS Pathways and the Directory of Services to triage patients calling the service.

The Trust serves a population of over 2.9 million, but is estimated to receive an influx of holidaymakers and visitors of around 17.5 million each year.

Derbyshire Health United

An Out-of-Hours service in Derbyshire went live with NHS Pathways in March 2011. A small number of call handlers are using NHS Pathways to triage patients calling the local out-of-hours number.

Derbyshire Health United are also planning and working towards integrating NHS Pathways with the central Directory of Services later in 2011.  This will support referral of patients to other community services.

Derbyshire Health United are now live with NHS 111 as part of the East Midlands NHS 111 project.

NHS Luton

In December 2010, NHS Luton became the third NHS 111 pathfinder site to implement NHS Pathways and the Directory of Services. In Luton, NHS Pathways and the Directory of Services is the underpinning technology to NHS 111 calls being handled by NHS Direct. They provide call handling, nurse assessment, health information and referrals to primary care through the integrated Directory of Services.

A link to the local Ambulance Service Computer Aided Dispatch (CAD) allows for an ambulance to be dispatched if the assessment finds the patient needs an emergency response, without having to pass the caller onto another operator for re-triage.

NHS Nottingham City and NHS Lincolnshire

Nottingham City and Lincolnshire became the second NHS 111 pathfinder site to go live with NHS Pathways and the Directory of Services in November 2010. Calls are handled by NHS Direct, using NHS Pathways, and are referred to the appropriate service through the integrated Directory of Services.

A link to the local ambulance service Computer Aided Dispatch (CAD) allows for an ambulance to be dispatched if the assessment finds the patient needs an emergency response, without having to pass the caller onto another operator for re-triage.

County Durham and Darlington

The County Durham and Darlington (CD&D) area in the North East are no strangers to NHS Pathways and the Directory of Services; the North East Ambulance Service (NEAS) has been using NHS Pathways and the Directory of Services since 2006.  CD&D have been receiving assessed 999 referrals into their local urgent care service, from NEAS for over four years.

Following the success of NEAS, CD&D started work to create a Single Point of Access (SPA) number for their area, in August 2010. This number would work alongside 999 and provides referrals directly into the urgent care service providers.

The SPA call handling was managed by NEAS. Initially callers dialled a 0300 number; after just under a year this 0300 number became 111.This means that if a patient called the 0300 number or 111 but required an ambulance there is no delay in dispatching one. The consistent clinical assessment of NHS Pathways is used for both the SPA/111 and 999, so callers to either service get a consistent response regardless of the number they called.

Early data from the Country Durham and Darlington pilot has shown a year-on-year drop of 4% in Accident and Emergency (A&E) attendance since the introduction of the 111 service. This compares to a 1.5% growth in the neighbouring Primary Care Trust area.

Read the eHealth Insider article on the 4% drop in A&E attendance

Fylde Coast Medical Services

Fylde Coast Medical Services (FCMS) went live with NHS Pathways in September 2009, to triage patients through their out-of-hours telephone line (24/7). This is manned by non-clinical call handlers who have been trained to use NHS Pathways.

In June 2010, a small pilot began at the reception of the Accident and Emergency (A&E) department at Blackpool Victoria Hospital. Patient who arrive at A&E are assessed in private booths using NHS Pathways, the same system as the out–of-hours service, before being directed to A&E or the co-located primary care service.

Satisfaction surveys have shown that patients are pleased with the out-of-hours service, because they get the right care for them either face-to-face or over the telephone.

December 2011 Update: NHS 111 has been launched using NHS Pathways and the DOS, serving Blackpool, North, East and Central Lancashire and Blackburn and Darwen. This is a joint venture between Fylde Coast Medical Services and NHS Direct.

North East Ambulance Service NHS Trust

The North East Ambulance Service (NEAS) have been using NHS Pathways as their primary triage tool for assessing 999 calls since December 2006. At NEAS, NHS Pathways is integrated with the Directory of Services.

As the 999 call handlers progresses the clinical assessment through NHS Pathways, the Directory of Services is filtering and locating primary care skills required by the patient for care, if they do not require an ambulance.

With the use of NHS Pathways and the Directory of Services NEAS are avoiding approximately 2000 inappropriate ambulance journeys each month.

Here are some of the NEAS team talking about their experiences:

More information

If you would like any further information about NHS Pathways implementations please contact nhspathwayscms@nhs.net