The weekend is typically a time when support from day-time health services is at a minimum or indeed difficult to access for Care Homes in the Norfolk and Waveney area. The volume of out of hours calls from Care Homes to NHS 111 are reported to be high over the weekend. The current process meant that Care Home staff have to contact NHS 111 for individual resident cases.
We approached IC24 who provide the NHS 111 and Out of Hours GP service in this area, to collaborate on improving safety and quality of care through a proactive approach so the resident would receive the right treatment at the right time in the right environment.
A high volume of calls to IC24 111 service from Care Homes has put a huge amount of pressure on the system. Many calls were resulting in unnecessary conveyances to hospitals, deconditioning of the resident from a hospital stay and therefore increased dependency. This affects the discharge plan on whether the resident can return to their Care Home or requires an alternative placement. It had also been identified that several Care Homes had a high proportion of calls with a low conveyance which demonstrated a need for more detailed triage and clinical support. Care Home staff reported they do not always feel confident in deciding who to call in an urgent situation or what information they need to provide. Many said they have felt scared and anxious when making an urgent call.
This pilot with IC24 was the first of its type in this region. The project aimed to reduce calls to 111 (and as a result also reduce 999 calls, attendances, conveyances and hospital admissions). This is a data driven project targeting those homes that have previously been frequent callers to NHS 111. Each Care Home is called by a clinician from IC24 twice on Saturday, Sunday and bank holidays to see if there are any concerns about residents and will then provide a video consultation or visit as appropriate.
The Care Homes were supported with NHSmail set up, ensuring access to shared mailboxes to enable access to the GOODSam video consultations. As an ICB we provided the Care Homes with tablets to ensure they were able to have the correct technology to complete the calls. As a team we contact the homes regularly to ensure any problems are rectified and to gain feedback to ensure success of the pilot.
Over 1000 calls have been made by IC24 since the pilot began and IC24 have committed to extending the pilot with plans to scale up.
All of the Care Homes taking part in the pilot have expressed they are not calling 111 or 999 as frequently, as they have the reassurance that a clinician will be calling twice a day, on weekends. Care Home staff have increased confidence and streamlined access to care for residents that are unwell.
In addition to the benefits to the individual, other benefits include:
- Additional support to care workers,
- Enhanced risk and crisis avoidance,
- Reduced transfer to ED via 999,
- Reduced risk of requiring hospital admission,
- Good resident experience,
- Building trust and relationships between IC24 integrated Urgent Care Service, the DHSC Team and Care Homes
“It was overall really good and supportive. We received a phone call first to discuss any residents we were concerned about. If we said we had concerns, then they sent the link. It was great to have a doctor on video.” – Care Home Proprietor
“They brought the tablet to me and I talked to a doctor. It was all very fancy. They gave me good advice to reduce the swelling on my eye.” Care Home Resident
“The pilot demonstrates the proactive nature of the service, and how partners/commissioners can work together to use digital tech to keep people well in their own settings, rather than being reactive.” – Communications Lead IC24