NHS 111 Leicester, Leicestershire and Rutland Operational

Management Plan

1. Introduction

This plan details the governance arrangements in place to manage the launch of the NHS

111 service delivered by Derbyshire Health United (DHU) in Leicester, Leicestershire &

Rutland and the on-going arrangements for governance of the service. It details the launch

and roll out timescales and describes the handover process from the project board into

business as usual including project sign off and formal project closure.

2. Milestones

Milestone Date Clinical governance review 23/07/13

Clinical governance approval to “go-live” 30/08/13

NHS England end to end testing successfully completed 02/08/13

Fitness for purpose check point review 1 signed off 06/09/13

Switch on National Numbering Groups (NNGs) 09/09/13

NHS Direct diverted to LLR NHS 111 service 10/09/13

Fitness for purpose check point review 2 signed off 20/09/13

West Leicestershire CCG OOH calls transferred to LLR NHS 111 24/09/13

Fitness for purpose check point review 3 signed off 11/10/13

East Leicestershire & Rutland OOH CCG calls transferred to LLR NHS 111 15/10/13

Fitness for purpose check point review 4 signed off 25/10/13

Leicester City CCG OOH calls transferred to NHS 111 29/10/13

NHS England end to end testing of Fosse House completed 15/11/13

Fitness for purpose check point review 5 signed off 22/11/13

Fosse House commences receiving NHS 111 calls 26/11/13

Project closure and hand over to business as usual 20/12/13

3. Governance Arrangements

The project governance is described in the diagram below:-

Appendix B 37

The Project team

The clinical governance structure for business as usual is described below.

4. Progress

The Directory of service (DoS) has been developed in LLR by the DoS Lead with the help

and support of the Clinical lead, Deputy Clinical lead and input from clinicians and

Commissioners of service from across Leicestershire. Testing of the DoS has been

extensive using the QDoS (Quality Directory of Services) testing tool and the results of the

tests and the ranking strategy which defines the order in which services are returned have

38

been reviewed and signed off by the LLR NHS 111 Clinical Commissioning Group and the

NHS England DoS Lead.

DoS Services are in the process of being switched to live with Pharmacy, Dentistry,

Optometry already having been switched on and visible Nationwide. GP opening times and

arrangements for patients who need to contact a GP between 8 a.m. and 6:30 p.m. when the

surgery reception is closed are currently being finalised prior to switching them “live” on the

DoS. Once a service is live it can be seen nationally and for GP practice this will mean they

could start to receive post event messages for any of their patients that contact a NHS 111

service in another area of England.

GP practices and those services where a summary of the triage is sent or where a warm

transfer is required are not live, see table below, these services will be switched live as close

to the launch date as practicable.

Provider What will provider receive?

GP Post Event Message and Warm transfer if "talk to within 1 Hr"

GP OOH Service (CNCS) Triage message to "call" or "see" or Warm transfer if "talk to

within 1 Hr"

Children’s Emergency Department Triage summary on call closure

LRI Urgent Care Centre (UCC) Triage summary on call closure

Loughborough UCC Triage summary on call closure

Market Harborough Minor Injuries

Unit (MIU) Patient Sign posted only

Oakham Rutland MIU Patient Sign posted only

Latham house MIU Patient Sign posted only

LPT Single Point of Contact Patient Sign posted only

SSAFA (Merlyn Vaz Centre) Walk in

Centre (WIC) Patient Sign posted only

Oadby and Wigston WIC Patient Sign posted only

Dental Patient Sign posted only

Pharmacy Patient Sign posted only

Optometry Patient Sign posted only

Testing

As part of the preparation for the launch of the service in September a rigorous test plan has

been developed and has been successfully completed and signed off. The test plan

consisted of both technical and operational testing by the project team which requires sign

off by NHS England before being given permission to go-live. The current status is that NHS

England has signed off the operational processes and DHU Call Advisors as ready for go-

live.

There is one remaining issue regarding repeat callers which has been identified as a

national issue which NHS England is working to resolve. In the event of the information not

being retrieved from the repeat caller database a flag is shown on the screen telling the Call

Advisor that the service is not available and reminding them to ask the patient whether they

have phoned more than three times in four days.

39

The technical testing is complete and the service is operationally and technical ready for

launch.

DHU Call Advisor and Nurse Advisor Staffing

One of the most important lessons learned both nationally and regionally is that having

sufficient trained Call Advisors and Nurse Advisors available is key to operating a successful

service. DHU operate the NHS 111 service for Derbyshire, Nottinghamshire and

Northamptonshire and the addition of the Leicester, Leicestershire & Rutland NHS 111

service requires recruitment and training of staff. The call model, which includes the

predicted call volumes for LLR, developed by DHU has been reviewed and confirmed as OK

by NHS England. The staff rota plan and its resilience to variations in call patterns has been

reviewed and the project board has assured itself that there are sufficient Call Advisors and

Nurse advisors available to meet the requirements of September. Staff availability and the

staffing rotas will be reviewed each week at the project board to ensure that sufficient Call

and Nurse Advisors are on the rota throughout the phased roll out.

Resilience

Resilience of the service is a key concern for the Commissioners and following a review of

the Providers Contingency and Business Continuity plans it was agreed that a table top

exercise would be carried out to test it.

Exercise Hillingdon took place at the Derby Conference Centre on 22 August 2013. This

was a table top exercise to look at the Derbyshire Health United Contingency and Resilience

Plan (v5.4) particularly looking at business continuity around the provision of the NHS 111

service. Participants in the exercise included representatives from Derbyshire Health United

(DHU) Local Medical Council (LMC), and Leicestershire Clinical Commissioning Groups

(CCG).

The exercise took the form of 4 injects which went through a severe weather and seasonal

flu scenario.

The aims and objectives for the exercise were

• To review the DHU Contingency and Resilience Plan (v5.4)

Objectives

• To review the plans ability to manage surge in activity

• To identify possible amendments to the plan in order to improve response to pressures,

in a timeline agreed with Project Board

• To identify of the outcomes of today what needs to be auctioned before 3 September

2013

• To highlight the impact on the wider system of any business continuity issues on 111

provision.

40

This exercise has showed that DHU’s plan mitigates the main risks to business continuity for

the NHS 111 service launch in Leicester, Leicestershire and Rutland.

It needs improvements to align to best industry standards (ISO: 22301) in a timescale which

has been agreed by the Commissioners

5. Mobilisation management

Prior to the launch of the first stage of the service and before the launch of each subsequent

stage a Fitness for purpose checkpoint review protocol must be followed. For the first stage

the “Go-live” checklist must be signed off by the Regional Director, the Area Director, the

CCG Accountable Officer, the NHS 111 Clinical lead and the Provider. For each subsequent

stage of the roll out the Area Director, the CCG Accountable Officer, the NHS 111 Clinical

lead and the Provider must sign off the check point, see NHS England NHS 111 Service –

Fitness for Purpose Checkpoint Protocol Version 2.

To ensure successful mobilisation of the service there shall be a number of meetings which

will be held to review the operational and clinical performance of the service:-

Meeting Week 1-8

(Mon 2/9 to Fri 25/10)

Week 9 – 12 (Mon 28/10 to Fri 22/11)

Week 13 -15 (Mon 25/11 to Fri 13/12/)

Week 16 (Mon 16/12)

Project Board Weekly Weekly Fortnightly N/A

Sitreps Daily

(7 days) Three times

per week Weekly N/A

Clinical Governance

Fortnightly Fortnightly Monthly Monthly

Call reviews Weekly Fortnightly Monthly Monthly

6. Clinical Leadership

In April 2013 the Clinical Lead Dr C Hewitt was offered a substantive post with the Local

Medical Committee (LMC) and resigned from the post at the end of May. This occurred

during the period when the June 11th launch date had been postponed and the new launch

date had not been agreed. The deputy Clinical lead, Dr P Flaxman remained in post.

Following discussion at the Commissioning Collaborative Board it was agreed by the three

CCGs that a new mobilisation plan was required quickly and to accomplish this a new

clinical lead was needed. In order to achieve this in the timescale required to mobilise the

service in 2013 the Commissioning Collaborative made the decision to approach a suitably

qualified local GP who would will willing to take over as interim clinical lead to see the

service safely through the roll out phase while ensuring processes were in place to recruit a

permanent LLR clinical lead. The interim lead will stay in post until the service has been fully

mobilised and until such time that the Commissioning Collaborative Board are assured that a

comprehensive handover has been completed.

Dr S Johri, a local GP and West Leicestershire CCG Board member with experience both as

an Out of Hours Service GP and as a member of the Out of Hours Performance and Review

group was approached and agreed to step into the role to guide the service through this

phase of the project.

41

It became apparent that the responsibilities of the clinical lead role were such that this is a

role in its own right and would need to be separate from any other clinical lead role within the

CCGs. An open recruitment process was then initiated to all GPs across the three CCGs,

overseen by a board level GP from each of the CCGs.

Dr Saurabh Johri was appointed as the permanent NHS 111 clinical lead at the end of

August, which has ensured that there will be continuity through the launch and roll out of the

service in LLR and into procurement of the new NHS 111 service in 2014.

7. Service Launch

The service is planned to be launched in a phased way commencing on the 3rd September

2013 with all NHS Direct, GP out of hours calls and public calls being transferred to the NHS

111 service by the end of October 2013. Since NHS Direct will be unavailable in

Leicestershire after 27th September, it will be the first service transferred to NHS 111 on the

3rd September. Following successful transfer of this service West Leicestershire CCG GP

out of hours call handling will be transferred to NHS 111 on 17th September. Three weeks

later, on 8th October, East Leicestershire & Rutland GP out of hours call handling will migrate

to NHS 111 and two weeks after that, on 22nd October, Leicester City CCG will transfer GP

out of hours call handling to NHS 111.

All of the calls from Leicester will be handled by DHU’s existing call centres in Derby and

Chesterfield with Fosse House out of hour’s call handlers remaining in post as a contingency

against any delays which could occur in the switch over of the service. During this period

the out of hour’s telephone number will remain active and patients that use it will be

connected directly to the OOH service. Once all LLR GP out of hour’s telephone calls have

been transferred to the NHS 111 service the Central Nottingham Clinical Services (CNCS)

Out of Hours call handling staff will TUPE across to DHU and commence training for the

NHS 111 service. The out of hour’s telephone number will then be discontinued and callers

will be connected to a message which asks them to replace the receiver and dial 111.

Health professionals will be provided with another number to allow them to contact the GP

out of hours service directly.

Following the successful launch of the service there will be a public launch which will

advertise the service more widely to the public within Leicester, Leicestershire & Rutland.

8. Communications and Engagement

There has been a significant and wide-ranging effort to ensure that there has been clinical

and patient engagement with the development of the NHS 111 service in LLR. This has

included the clinical governance meetings, development of the DoS with local clinicians,

communications to GP locality meetings, GP Practice Protected Learning Time and a

significant amount of time communicating with patient forums, particularly those that

represent the hard to reach groups.

As the project approaches the launch date significant effort is being made to ensure that

clinicians, particularly local GPs, are aware of the launch timetable and the impact that the

service will have on them when it launches. Communications regarding the approaching

launch has been delivered to GP locality meetings during July and further information will be

presented in August to prepare GP practices for launch. In September and October Clinical

42

Leads will attend locality meetings again to gain feedback following launch. In preparation

for the launch each Practice Manager will be sent a pack in August which will contain simple

explanation of the service provided by NHS 111, what the impact will be on GP practices

and what practices need to do. In each CCG immediately prior to switching the GP OOH

service to NHS 111 practice managers will receive further instructions with a script for new

telephone messages and when they should be changed.

Clinicians across LLR will be encouraged to provide feedback and an easy to use web page

has been created to make it easy for busy clinicians to do this. All feedback forms will be

reviewed by the Clinical Lead or his deputy to ensure that the key issues are identified. This

feedback will inform the types of call which will be reviewed during the regular call review

meetings.

9. Fosse House

Following Call Advisor training, a period of readiness testing will be carried out locally. This

will involve the Commissioners testing the Fosse House Call Advisors with a number of

scenarios over a two to three day period. Prior to go-live NHS England will repeat the

scenario testing to ensure that the Call Advisors are sufficiently competent for the service to

be delivered from Fosse House.

Following the launch of Fosse House as a NHS 111 call centre, daily Sitreps specifically for

Fosse House will be initiated which will continue until the service delivered from Fosse

House is achieving the KPI’s defined in the minimum dataset.

10. Transfer to Business as Usual

The decision to close the project and transfer clinical governance and performance

monitoring to business as usual shall be taken based upon a number of criteria:-

• Service performance against the minimum dataset

• Clinical Governance group satisfaction regarding the quality of the calls and the

appropriateness of the dispositions.

• Satisfaction of patients with the service

• Assurance by the clinical governance group regarding the resilience and flexibility of

the service and the readiness to respond to winter pressures

In addition to the above criteria the project board will require assurance that any issues and

risks have been satisfactorily resolved or are known and responsibility for managing them

going forward has been accepted by the contract manager.

In preparation for the project closure a lessons learned review shall be completed with the

clinical governance group and the wider project team which will be included in the overall

project closure report.

The decision to formally close the project and transfer to business as usual will be made by

the Leicester, Leicestershire & Rutland Commissioning Collaborative (CCB) based upon a

closure report from the project board with evidence showing satisfactory delivery of the

operational performance and clinical criteria and a record of any remaining risks and issues.

Once the closure of the project has been agreed by the LLR CCB the Senior Responsible

Officer will ensure that all project documentation is archived and the recommendations from

43

the lessons learned report are known and understood by the Senior Responsible Officer for

the procurement of the 2014 NHS 111 service. The 2013 NHS 111 project will then formally

close and on-going responsibility for the monitoring and performance management of the

service being handed to the East Leicestershire & Rutland contract manager.

44