Impact of paediatrician involvement in nhs 111 clinical assessment services

ABSTRACT

Background More children and young people (CYP) attend Emergency departments (EDs) each year than over-65s and CYP account for up to 40% of all primary care consultations. Many CYP seen in ED or primary care are triaged through NHS 111, which is a free telephone service, wherein all calls are initially triaged by a call-handler. Where appropriate, calls are passed on to the Clinical Assessment Services (CAS) for a call-back from a clinician. During the Covid-19 pandemic, NHS 111 experienced an increase in volume of calls offered. Objectives To support NHS 111 providers in responding to paediatric calls during the Covid-19 pandemic, and to assess the feasibility of including paediatric expertise within NHS 111 CAS and its impact on service delivery. Methods In May 2020, 70 paediatric clinicians, identified via the RCPCH (or locally), were on-boarded and trained to work remotely within the CAS of six NHS 111 providers in England. Across all six NHS 111 provider sites, the volunteers worked alongside existing CAS clinicians, providing call-backs to carers of paediatric cases under 16 years old, irrespective of the presenting complaint. Data were gathered from existing NHS 111 provider systems to include immediate outcomes (dispositions) and patient/carer feedback. Contributing paediatric clinicians and NHS 111 staff were surveyed by questionnaire and/or phone call. Results 2535 paediatric cases were taken by paediatric clinicians and 137,008 paediatric cases by non-paediatric clinicians working in the six NHS 111 providers from 25th May to 4th December 2020. Disposition rates varied between the calls taken by paediatric vs non-paediatric clinicians (table 1). ∗ ∗All categories significant at p<0.01 e.g. self-care versus primary care referrals χ2 (df =1, N = 78938) = 37.95, p<0.01 Survey data from 62/70 volunteers indicated that they enjoyed working for NHS 111. NHS 111 staff surveyed (n=14) and interviewed (n=5) reported that paediatricians contributed to improving the service delivery to young patients. Feedback from carers whose calls had been taken by paediatric clinicians at one NHS 111 provider (n=60) showed higher satisfaction rates when compared with national averages for all calls (including adults and children) (92% vs 67%), with more reporting that their problem was resolved (92% vs 26%). Conclusions The data showed that enhanced paediatric support within NHS 111 CAS is likely to reduce the large volume of children advised to attend ED or primary care, while improving the families' experience. Further work will explore the longer term outcomes within the NHS, and more detailed carer feedback. In future, more integrated models of care for CYP needing urgent and emergency care services may be achieved by this means, and better access to alternative healthcare support through hospital or community-based services, such as rapid access clinics.