Guest Blog Part Two: Implementation of the Call First model

By Mark Cockerton

This blog continues the themes of a previous post, which can be read here The pressures of the Covid-19 pandemic are likely to mean that the Call First model must be implemented at an unprecedented pace if it is to fulfil the aim of avoiding overcrowding and facilitating social distancing in locations offering walk-in access, including A&E and Urgent Treatment Centres.  NHS 111 is already often operating at close to capacity with its current services and the Call First model will mean a very large increase in call volumes. Many callers to NHS 111 experienced long delays at the height of the pandemic, so it would be optimistic to assume that delivering a Call First service during a potential 2nd wave isn’t going to be problematic, if NHS 111 infrastructure alone is relied on.

What will the approach to implementation be?

The current pilots in London and Portsmouth will need to be evaluated over a period of time. Given the urgency, it is likely that the evaluation period will be relatively short. Following that evaluation, even a fast-tracked competitive tendering procurement process would take a minimum of at least 3 months, with a further 3 months at least required to mobilise the new service. My view is that the pressures of Covid-19 and the potential for a second wave during winter is likely to mean that NHS England will want to move considerably faster than the usual competitive procurement processes would allow. I anticipate that there will be further pilot arrangements established and temporary contract variations made to facilitate those.

My hope is that the pilot Call First sites will take account of the learning from previous roll-outs of urgent care call handling services outlined in this paper. With an implementation that needs to be delivered at an unprecedented pace, it is going to be vital to secure buy-in from those providers already providing urgent care services in the local healthcare community. It would greatly assist that buy-in if the opportunity is taken to benefit from the existing capacity available at providers that are not currently providing NHS 111 services.

There is considerable call handling infrastructure already in place and not being currently fully utilised (including premises, IT, telephony and experienced staff) where contracts have been lost by Providers to NHS 111.  I know from my own experience that the GP Out of Hours and urgent care providers who have that capacity available are able to move very quickly indeed.

It would be refreshing to see Commissioners and Providers working together creatively and without needing to resort to competitive tendering processes to quickly bring available local capacity into use in order to implement the earliest start date for whichever Call First model proves to be effective in the pilot sites. With goodwill on all sides there is a real opportunity to reverse 20 years of less than optimum integration and joint working between organisations providing services to patients.

A specification that all service providers must follow to ensure service quality, is essential. Use of NHS Pathways may well be a part of that specification although alternative clinical decision support systems are available. Agreement of a national cost per case for providing Call First services would be very helpful.

Call First is not currently part of the specification for NHS 111 services, as they are currently commissioned.  There is therefore a risk of legal challenge if competitively tendered contracts were amended to a significant level without further competition. National guidance that approval for Call First pilots will be dependent on agreement between NHS 111 providers, GP Out of Hours providers and all other members of the local urgent healthcare community would help to mitigate that risk.  An implementation timetable that necessitates all available existing infrastructure to be utilised, rather than embarking on capital expenditure would also help to facilitate creative joint working.

How SESUI can help 

Observing the implementation of call management cloud telephony in a range of settings and always to a schedule that seems impossibly tight, leads me to believe that SESUI is ideally placed to assist the roll-out of Call First services. Using the cloud to integrate existing telephony equipment in different Providers means that implementation is far quicker than when new equipment needs to be commissioned. I’ve been involved in several mobilisations with exceptionally tight time pressures and SESUI has always delivered.

During the Covid-19 pandemic, we’ve seen a huge change in the attitude towards working from home, or in locations away from the main base. Organisations that were previously reluctant to permit remote working, often in the belief that productivity would suffer, are now enthusiastic about the opportunities it can bring. The SESUI system allows call centre access for clinical and operational staff using any phone, fixed or mobile. Calls can be recorded at any location and whatever telephone is used the cost of the outgoing call is charged to the provider – something that is administratively far simpler than arranging for expenses re-imbursements. The performance management system enables organisations to monitor effectiveness wherever the user is based. In real-time, if required.

Resilience is facilitated by the flexible solution provided by SESUI. Calls can be re-directed in any agreed pattern to meet the demand profile at any time.

SESUI has always proved itself on innovative and flexible solutions to call management problems and has a detailed understanding of the needs of the urgent healthcare sector.

Is flexible cloud call management telephony across a range of settings an approach whose time has come? I think it is.

Now more than ever, flexible cloud call management, facilitating numerous providers, is the collaborative solution bringing the most benefit to the NHS.

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