5.1. The Committee considered a report on the procurement of a Sussex-wide Out of Hours (OOH) Home Visiting Service. The Committee then asked the witnesses present a number of questions.
5.2. The Committee asked why the OOH Home Visiting Service was being procured separately to the new NHS 111 service.
5.3. Colin Simmons, Integrated Urgent Care Programme Director, Coastal West Sussex CCG, explained that the procurement that was paused last Summer had been for a Sussex-wide NHS 111 service. He said he could not go into all the reasons why it was stopped, due to procurement confidentiality, but it did include an OOH Home Visiting Service. The reason for the changes included:
5.4. The Committee asked whether there was a risk that recruitment to the service would interfere with attempts to recruit to other emerging urgent care services.
5.5. Colin Simmons agreed workforce recruitment and retention was an issue but was also an issue across the whole of the NHS. To tackle this issue, the OOH home visiting service will have a mix of clinical skill sets – whereas the current service is predominantly GP-based – enabling patients to see paramedics, or advanced nurse practitioners in certain circumstances. Plans are also being developed to use the workforce in the most flexible, constructive way, for example, establishing whether clinicians in the NHS 111 Clinical Assessment Service (CAS) could work for a different provider, i.e., the provider of the Home Visiting Service, to enable the clinician to vary their workload in a way that suits them.
5.6. The Committee asked how the CCGs can ensure that providers deliver on any promises to provide the workforce set out in the service specification.
5.7. Colin Simmons explained that part of the role of all commissioning organisations is to hold providers to account to deliver on their promises, but CCGs can also encourage providers to work together to help ease workforce issues.
5.8. The Committee asked how the service might overcome the issue of a shortage of GPs
5.9. Colin Simmons explained that the shortage of GPs would be overcome in part by developing a multidisciplinary team including paramedics, advanced nurse practitioners and GPs. Whilst GPs will still be required for certain clinical interventions, these other staff could help support the GPs’ workload. It will also be necessary to develop ways of making the service seem more attractive to prospective GP, given the traditional issues with OOH services appearing unattractive employment opportunities.
5.10. The Committee asked about how oversight of this potentially complex urgent care system could be ensured.
5.11. Colin Simmons explained that the CCGs’ role in ensuring different providers work together across the urgent care system will involve being clear about the expected outcomes of the new integrated urgent care system, as well as looking at the clinical governance arrangements for handing patients from the care of one provider to another are safe for patients.
5.12. The Committee asked how access to summary care records could be shared between the ICT systems of NHS 111 and the OOH Home Visiting Service
5.13. Colin Simmons explained that call-handlers for NHS 111 can currently access summary care records. In future the 111-CAS clinicians, if they need to look at further details, will be able to view full patient records, although they will require a patient’s consent. There are a multitude of different ICT systems in use by the different urgent care providers and the current interim 111 contract for 19/20 involves testing out how these can best be linked together.
5.14. The Committee asked when new innovations are introduced how it can be ensured they work correctly
5.15. Colin Simmons agreed it was important to ensure new technology, such as video calling instead of face-to-face appointments, is used to help improve services for patients, but it also needs to be understood they will not be appropriate for all situations. Patients will also need to be made aware of such technologies and be comfortable using them, and some clinicians will also need to see the benefits demonstrated to them. he believed that there needs to be stakeholder engagement and plans to pilot some of these technologies.
5.16. The Committee asked whether the procurement timeline was short and whether there was confidence there were providers able to take on the service.
5.17. Colin Simmons agreed it was a tight timeline but the mobilisation period of three months was not considerable due to the size of the service. The 111-CAS, on the other hand, had an eight month mobilisation period in recognition of its size. Nine providers showed interest in the OOH Home Visiting Service during an engagement event, suggesting there is interest in the market to provide the service.
5.18. The Committee asked what will happens to patients assessed by the CAS
5.19. Colin Simmons explained that the 111-CAS will consider a patient’s need over the phone and, if necessary, assign an appropriate time period in which the OOH Home Visiting Service will need to visit them. This will be either two, four or six hours. 111 will pass the referral on to the OOH Home Visiting Service with the response time indicated and the OOH service’s target will be to respond within that time. 111 will then carry out comfort calling every so often during that period to check if the patient is ok and their needs have not changed.
5.20. The Committee RESOLVED to note the report.