Norfolk and Wisbech (excluding Great Yarmouth) Integrated NHS 111 and OOH Service

Overall Assurance Pack (Final Draft Version 1.0) SRO: Nicola Cocks CCG Leads: Norwich – Nicola Cocks North Norfolk CCG – Tony Belham South Norfolk CCG – Chris Coath / Wendy Hicks West Norfolk CCG – Cal Deane Wisbech LCG – Chris Humphris / Delyth Yates

Agenda Item: 9.3a

Meeting: SNCCG Governing Body

Date: 28 July 2015

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Approved By: SRO: Nicola Cocks ------------------------------------------------------------------ CCG Leads: ----------------------------------------------------------------- ----------------------------------------------------------------- -----------------------------------------------------------------

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1. Introduction

This pack contains a detailed account of the Assurance measures in place and being worked through to safely mobilise the new Integrated NHS 111 and Primary Care OOH Service due to Go Live on the 1st September 2015 This service was procured collaboratively using robust procurement protocols and was awarded to the successful bidder in April 2015. The service is being provided to the population of Norfolk and Wisbech, excluding Great Yarmouth. The service will transfer to a new provider and thus a detailed mobilisation, demobilisation and transition plan has been constructed to move the current service provided by EEAST in the Norfolk area and Herts Urgent Care (NHS 111) and Urgent Care Cambridge (OOH) in the Wisbech areas safely and effectively. This assurance pack provides the evidence on which the Senior Responsible Officer and the respective CCG Leads have assured themselves that the new service being mobilised is safe and effective to Go Live on 1st September. The mobilisation draws on the experience and lessons learned from delivering the NHS 111 and OOH service over the past three years. NHS England have been working with a number CCGs and staff nationally to develop procurement and mobilisation guidance for NHS 111, for OOH and importantly for Norwich and Wisbech an Integrated NHS 111 and OOH Service. This guidance was not made available to us until midway through mobilisation. The provider of these new integrated services is IC24. IC24 are an established provider of NHS 111 and OOH services. The current provider is East of England Ambulance Service (EEAST). Commissioners, EEAST and the incoming provider IC24 have worked diligently and professionally to ensure a safe hand over of the services with minimum disruption to patients, staff and other health professionals and services. The expectation is that the service transition will be seamless. Patients dialling 111 following handover should see no disruption in service. The service is still being provided in the local area and many of the staff delivering the service will remain the same as the roles are protected under TUPE Patients requiring an OOH GP who contact their own GP to do so will be played an answerphone message directing them to call 111 who will help them. Patients directly dialling the previous OOH number will also hear a recorded message advising this service is no longer operating and directing them to call 111. Patients on the borders of the covered area may on dialling 111 get through to a neighbouring NHS 111 service. All NHS 111 service providers are obliged to provide a service to ‘Out of Area’ callers that meets the NHS 111 specification regardless of where they are calling from In addition the Integrated NHS 111 and Primary Care OOH Service Project SRO and the Clinical leads for the respective CCGs have assured themselves that the service is safe and effective and have created a comprehensive Clinical Governance framework which can be found in Appendix 2.

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2. Local Context

2.1 Local population and commissioning arrangements The service to be provided is commissioned to cover the Norfolk and Wisbech population excluding Great Yarmouth. IC24 currently provide services to Great Yarmouth & Waveney CCG under a separate contract. The estimated population for this service is 830,0000 patients and are the responsibility of 4 CCGs and 1 LCG in the area to be covered and these areas are broken down in terms of GP practice and population as follows:

CCG No of GP Practices Approx. patient population

Norwich CCG 22 213,000

North Norfolk CCG 20 169,000

South Norfolk CCG 26 229,000

West Norfolk CCG 23 169,000

Wisbech LCG 4 50,000

There are also 3 prisons in the local area which will be covered for urgent OOH care by IC24 under the terms of this contract. These are:

HMP Norwich

HMP Bure

HMP Wayland

2.2 Local Emergency and Urgent Care Services 2.2.1 999 Service is provided by:

East of England Ambulance Service (EEAST). 2.2.2 Acute Care in the area is provided by:

The Norfolk and Norwich University NHS Foundation Trust, Colney Lane, Norwich, Norfolk, NR4 7UY http://www.nnuh.nhs.uk/

The Queen Elizabeth Hospital Kings Lynn, NHS Foundation Trust, Gayton Road, King's Lynn, Norfolk, PE30 4ET http://www.qehkl.nhs.uk/

2.2.3 Community Care in the area is provided by:

Community Care in the Norfolk contract area is provided by Norfolk Community Health and Care NHS Trust (NCH&C), Elliot House, 130 Ber Street, Norwich, Norfolk, NR1 3FR http://www.norfolkcommunityhealthandcare.nhs.uk/ This provider also has a number of community hospital beds who’s out of hours medical cover will be now be provided by IC24 as the Primary Care OOHs Provider

Community Care in the Wisbech area is provided Uniting Care Partnership (UCP), Block 2, Ida Darwin Hospital, Fulbourn, Cambridgeshire, CB21 5EE http://www.unitingcare.co.uk/ Community hospital beds for the Wisbech area are provided at North Cambridgeshire Hospital, The Park, Wisbech, Cambridgeshire, PE13 3AB http://www.cambscommunityservices.nhs.uk/

2.2.4 Mental Health Care is provided by:

The Mental Health provider for the Norfolk contract area is Norfolk and Suffolk NHS Foundation Trust, Hellesdon Hospital, Drayton High Road, Norwich, Norfolk, NR6 5BE http://www.nsft.nhs.uk/

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The Mental Health provider for older people in Wisbech is UCP, Block 2, Ida Darwin Hospital, Fulbourn, Cambridgeshire, CB21 5EE http://www.unitingcare.co.uk/and for adults, young people and children is Cambridgeshire and Peterborough Foundation Trust (CPFT). Elizabeth House, Fulbourn Hospital, Fulbourn, Cambridge, CB21 5EF http://www.cpft.nhs.uk/

3. The Project Board and Project Structure In order to ensure sufficient expertise and capacity during procurement and mobilisation the CCGs’ secured the services of Attain Commissioning Services to lead this piece of work. The timelines between announcement of preferred provider and the service going live was extremely challenging so it was agreed that some mobilisation activity would take place ahead of the announcement (e.g. setting up the Project Structure and meetings etc). Mobilisation formally commenced in April 2015 following the announcement of the successful bidder.

3.1 Project Board Structure

The Mobilisation Project Board was set up comprising of a robust project office leading a series of individual work-streams and actively involving all CCGs. To ensure full collaboration across the whole area a matrix structure was developed with CCG representatives taking on the role of Work-Stream Leads as well as representing the views of their individual CCG or LCG The CCG Reps are:

Norwich CCG Peter Spears

North Norfolk CCG Tony Belham

South Norfolk CCG Chris Coath – delegated to Wendy Hicks

West Norfolk CCG Cal Deane

Wisbech LCG Chris Humphris – delegated to Delyth Yates

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3.2 Project Board Terms of Reference See Appendix 1

4. Work-Streams A number of Work-streams were identified as crucial to the safe and effective mobilisation of the Integrated NHS 111 and Primary Care OOHs Service. These work-streams are briefly described below:

4.1 Clinical The full Clinical Governance Pack is found at Appendix 2 and should be read in conjunction with this document to understand the clinical assurance and governance of this mobilisation. The clinical work-stream was established early into the mobilisation. NHS England had clear guidance for the clinical assurance and clinical governance of NHS 111 but there had been no similar guidance for OOH or for an Integrated NHS 111 and OOH Service. The Clinical work-stream adapted the existing guidance to include OOH and have produced an Integrated NHS 111 and Primary Care OOH Clinical Governance Pack., It demonstrates how clinical assurance has been gained in order to permit the new service to

a) Go live on 1st September 2015 and b) Continue to assure the CCGs of the clinical safety and effectiveness of the service

Each CCG has a nominated Clinical Lead to represent their CCG in the development of the Clinical Governance Structure and Processes as well as the process of assurance clinically for Go Live. The Clinical Leads are also responsible for the clinical sign off of the Directory of Services (DoS) for their particular area. The Clinical Leads are:

Norwich CCG Dr Victoria Stanley

North Norfolk CCG Dr Penny Ayling

South Norfolk CCG Dr Keeva Rogers

West Norfolk CCG Dr Imran Ahmed

Wisbech LCG Dr Andrew Wordsworth

As Norwich CCG is the coordinating commissioner for this service Dr Victoria Stanley has undertaken the role of ‘lead’ or ‘coordinating’ Clinical Lead for this mobilisation and implementation. There is still an overall National Clinical Governance Group for the NHS 111 service with representatives from all regions involved. Dr Stanley has ensured that the Regional NHS Clinical NHS 111 representative has been kept fully informed of the procurement and mobilisation of this service. 4.1.1 Clinical Assurance for Go Live The Work-stream leads have used the clinical assurance process from previous NHS 111 service mobilisations and adapted those to include OOH for this service. They have developed a series of clinical scenarios to be used to assess the provider’s capability to Go Live the detail of which is contained in Appendix 2 (Clinical Governance Pack) The scenarios will be tested in a table top exercise with the provider on 29th July 2015. This is a commissioner led activity and requires local commissioner sign off. NHS England have been kept fully informed of our mobilisation and assurance plans and have agreed to participate in the assessment process on 29th July.

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Additionally all the clinical policies required through the ITT process were assessed by the clinical evaluators on the procurement evaluation panel and have been retained with the contract as ‘documents to be relied upon’ IC24 are CQC registered as evidenced in the ITT process. Recent changes regards registration have required IC24 to ensure all bases and the Norwich Contact Centre separately registered with the CQC. Applications have been made for all and these can be found in Appendix 8 (these are currently under development and will be completed ahead of go live 01/09/15) 4.1.2 Clinical Governance of the Integrated NHS 111 and OOH Service The clinical work-stream were also tasked with creating a robust clinical governance structure and process that transcends services to ensure the clinical safety and effectiveness of the service for patients. See Appendix 2.

4.2 Information Management and Technology Both NHS 111 and OOH are very heavily technology driven. NHS 111 in particular has a very prescriptive specification to ensure that patients accessing 111 will get the same service whichever NHS 111 service answers. The ITT process ensured that the successful bidder was able to meet the technical specification to deliver NHS 111 and also to deliver an effective OOH service. The provider must be Registration Authority (RA) Compliant and all staff must have a Smart Card with appropriate permission level. All staff have relevant access and training supported by the RA agent. This is supported by Norfolk & Great Yarmouth and Waveney RA Manager. IC24 have signed our contract for Norfolk Smart Cards and have appropriate systems and processes in place for the management of Smart Cards and RA overall. Appendices 3 through to 7 inclusive have been collated to demonstrate the assurance undertaken to ensure that the service meets the required technical specification and when it has been fully tested will be ready to Go Live from a technical perspective.

4.3 Workforce 4.3.1 Staffing Levels IC24 submitted workforce plans across the whole NHS 111 and OOH service within their bid. This took into account expected demand based on hard intelligence from activity data provided by commissioners from previous years of service provision and IC24’s own knowledge and experience of the service to be provided. IC24 committed to a period of ‘over – establishment’ to lessen the impact that the changeover of service could have. TUPE numbers are not officially known until 28 days prior to handover and even then staff on the TUPE list can chose to not move right up to the day of transfer if they wish. In order to mitigate this risk, IC24 have over staffed initially. The rationale included the fact that if there was then additional capacity in the system this would be welcome to:

a) Ensure agreed KPI’s are achieved and, b) To make the transition to IC24 for existing staff and the start of a new job for

brand new staff A fuller description regarding the staffing model is available within the Clinical Governance pack in Appendix 2.

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Commissioners have reviewed the scheduling and assumptions provided by IC24 and found that the tools used to forecast and plan are industry standard and that the assumptions relied on appear sensible. We are therefore assured of the process undertaken to achieve the staffing profile. The commissioner is also reassured that IC24 have measures in place to monitor performance against Key Performance Indicators (KPI’s) and would recognise when capacity issues were arising. IC24 have adequately described measures they could and would take to address any demand and capacity issues (which again are covered in detail in the Clinical Governance Pack in Appendix 2). Contract management mechanisms in place will ensure that any issues that do arise and are not recovered can be addressed through the contract. 4.3.2 Recruitment and Selection IC24 have an ongoing recruitment plan to ensure that all aspects of the service are optimally covered with substantive staff. Their staffing model aims to keep the use of bank and agency staff to a minimum. GP’s are employed on a sessional basis but IC24 actively seek to utilise local GP’s who are on the local GP performers list which will ensure there is a high level of local knowledge and real linkages into the local health agenda. IC24 recruit using competency based assessments and have a high success rate in retaining high quality staff by exercising this at the recruitment stage. IC24 are providing the commissioners with weekly reports on recruitment across the integrated service and skills sets so that commissioners are sighted on the fulfilment of the staffing profile as we move towards the Go Live date. 4.3.3 Training and Development All staff are given the required training to complete their respective roles within the service. This includes mandatory training, system training including NHS Pathways (where relevant to role) and enhanced role specific training. All staff have a Personal Development Review (PDR) which informs their individual training plan. IC24 have a training team who are supported by the Human Resources (HR) department to ensure that IC24 remains an active learning environment. More detail regards training and development of staff is in the Clinical Governance Pack in Appendix 2.

4.4 Estates The estate for the Integrated NHS 111 and Primary Care OOH Service comprises a Contact Centre for answering the NHS 111 calls in Norwich. This maintains a local presence. The OOH bases will also remain at or close to existing locations. Norwich Commissioners have committed to colocation of the Norwich base at the Norfolk and Norwich Foundation Trust (N&NFT). This is not possible from contract start so the current base in Norwich will remain in operation until that is secured. Wisbech LCG also wished to move their base from North Brink to a more suitable site at the North Cambridgeshire Hospital to encourage patients in Wisbech to access the OOH service rather than A&E care where appropriate. All bases and the Contact Centre have been registered with the CQC see Appendix 8

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4.5 Communications and Engagement As the coordinating CCG Norwich has led the Communications and Engagement work-stream and engaged with other CCG and provider communications leads in doing this. The communications leads are:

Norwich CCG Tim Curtis

North Norfolk CCG Max Bennett

South Norfolk CCG Oliver Cruikshank

West Norfolk CCG Emily Arbon

Wisbech LCG Amiee Johnson

IC24 Gilly Carliell

EEAST Adam Gretton

UCC Via Wisbech i.e. Aimee Johnson

The Communications and Engagement Leads have liaised with local health watch and patient groups to ensure engagement initially for procurement and specification development and latterly for the mobilisation and implementation. A Communications Strategy was developed and can be found in Appendix 9. NHS E have a national rolling NHS 111 promotion planned and the commissioners have asked that the Norfolk area is not targeted for this initially. Promotion of the NHS 111 service will remain on the agenda for review once the service has launched and stabilised as encouraging patients to access services via an NHS 111 assessment is the best way of ensuring patients attend the right service at the right time. Any promotion will be agreed with CCG’s and IC24 before being undertaken. There has been very active communications with GP practices (clinical and operational) via the Communications and Engagement Leads and directly by IC24 to ensure close working relationships. Guidance has been given regards call routing and all practices have been advised that they must use an answerphone message to direct patients/callers contact GP’s after normal hours to redial 111 if urgent advice or treatment is needed. Additionally IC24 have been very proactive in engaging with the local GP community and Dr Mark Reynolds (IC24 Medical Director) has done a series of face to face sessions locally to meet GP’s from the area. IC24’s working Communications and Engagement Plan can be found in Appendix 10 IC24 establishing a Stakeholder Project Board to ensure this engagement is integral to the service provision throughout the lifetime of this contract

4.6 Information and Corporate Governance IC24 have demonstrated compliance with IG and are contractually required to maintain that compliance throughout the lifetime of the contract. Any breaches will be highlighted and dealt with through normal contract mechanisms. Where Information Sharing Agreements (ISAs) are required, the CCGs are working the NEL CSU IG lead to ensure that they are identified and in place. This includes an ISA between IC24 and HPA to allow HPA to receive syndromic surveillance data regarding the service. Please see Appendix at 11 for relevant ISA’s (these are currently under development and will be completed ahead of go live 01/09/15).

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4.7 Directory of Services The Directory of Services (DoS) is a national database populated locally to sit behind the NHS 111 Clinical Decision Support System (CDSS) which in this instance is NHS Pathways. (There are other triaging tools available that meet the required specification but NHS Pathways is so far the tool of choice in the current NHS 111 providers and is the one in use by IC24) Local commissioner are responsible for the DoS and should ensure that the DoS is fully populated with the available services in the area and that these services are profiled correctly and ranked appropriately. This will ensure that the NHS Pathways assessment will generate an appropriate DoS endpoint. Clinical leads are integral to this process as they are charged with ensuring the DoS is returning appropriate endpoints and in fact carry out DoS endpoint testing on a regular basis Current NEL CSU manage the DoS in this area and the Wisbech area is covered by Cambridgeshire and Peterborough CCG. The DoS lead at NEL CSU is Anna Clarke and Anna has worked very closely with the Clinical Leads across the area and also the DoS Manager in Cambridgeshire and Peterborough to re-validate the DoS ahead of the new service launch. Additionally IC24 have worked with Anna and other health care providers (e.g. NCH&C) to ensure all available referral points are in the DoS and accessible to service users accessing services via NHS 111. They have an ongoing plan to maintain these communications to ensure services develop. The DoS SOP is currently under review and will be refreshed ahead of the service going live on the 1st September 2015. The SOP includes details of how the DoS is maintained and developed, how users can highlight any issues, omissions etc and how commissioners can obtain a regular gap analysis that will help inform future commissioning decisions. It also takes into account the schedule for regular and ad hoc updates. The DoS Manager is also an integral part of the Clinical Quality Review Group (NB this is a working name for the group and may be changed before Go Live) updating the group regards DoS issues and reviewing potential new pathways The DoS SOP can be found at Appendix 12 (this is currently being refreshed and will be completed ahead of go live 01/09/15)

5. The Mobilisation Plan Commissioners have worked with both EEAST and IC24 to fully mobilise the service to be provided by IC24 and demobilise the service currently provided by EEAST This has been recognised by all involved as a very challenging timeline however detailed mobilisation plans used by the provider and commissioners indicated that this is achievable. See Appendix 13 for Mobilisation Plan

6. Service Resilience IC24 were required to provide detailed resilience and business continuity plans as part of their bid submission and these have been fully evaluated by the procurement review team.

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No issues were highlighted by the evaluation team regards these plans and these plans are being tested as part of the Service Assurance Event being held on the 29th July 2015. Any use of either of these plans during the contract will be reported to the commissioner as per contractual requirements.

6.1 Resilience plans in place for the NHS 111 service IC24 has planned the appropriate systems are in place to safeguard patient safety and service quality. Business continuity is a core component of risk management and the emergency planning and resilience needed for a service such as this is vital to minimise interruptions to the service. Interruptions to NHS 111 service provision will have an immediate knock on effect to the other health services such as 999 and ED therefore the service must be maintained. To that end the CCG evaluation team and subsequently the IM&T work-stream lead, Operational Lead and Programme Lead have reviewed IC24 Business Resilience around the NHS 111 service and are satisfied it meets the requirements. Additionally all resilience and backup process are scheduled to be thoroughly tested through the mobilisation period in assessing the services readiness to go live. Enough time has been built into this schedule to allow for remedial actions to be taken should these be required. A desktop exercise to test the people component of these processes is scheduled to be held on the 29th July 2015 again leaving enough time for remedial actions to be taken if issues are identified. Back-up systems are scheduled to be checked regularly throughout the life of this contract. IC24 have local business continuity provided by having 3 separate contact centres that can all deal with all NHS 111 services they deliver. Therefore if the Norwich contact centre is not available for any reason the calls will route through to and be picked up by the Ipswich and Ashford contact centres. Nationally there is an element of resilience in that a proportion of all calls in normal operations are distributed ‘out of area’ and NHS 111 providers are required to be able to respond to these calls. Because of this other providers are able to deal with ‘out of area’ calls in the event of an emergency where calls may need to be distributed nationally for a time in response to an unexpected emergency. This contingency can only be invoked by the National NHS 111 team.

6.2 Resilience plans in place for the Primary Care OOH Service

IC24 have resilience plans supporting the delivery of the OOH service that cover all aspects of service delivery from loss of base, staff shortages and adverse weather. We complete regular table top exercises to test and assure the plans. Service resilience is underpinned by contingency plans and clear SOPS with management and clinical on call rotas. More detail regards Business Continuity and Resilience is contained within the Clinical Governance Pack in Appendix 2.

7. Go Live and monitoring Below is a description of how the week prior to go live, the Go Live date itself, week following go live and 4 weeks following go live will be managed from a clinical monitoring perspective

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7.1 Week preceding Go Live A conference call, for final readiness checks, will be held each day in the week preceding Go Live, including on the Bank Holiday the day before Go Live. Each day on these calls a review of readiness will be undertaken against a ‘Go Live’ Checklist and issues and risks will be managed or escalated as appropriate. At the end of each scheduled call the group will confirm that Go Live remains on track and specifically the Clinical Leads of the provider organisation and the commissioners will be asked if they are clinically assured of the safety of the service going live. Further detail is included in Appendix 2 (section 14).

7.2 Daily SITREP production In respect of NHS 1111 to support monitoring the service, there is a national requirement for the provider to send the commissioner a daily situation report (SITREP) in a prescribed format measuring the six national KPIs. As this is an integrated service we have agreed that this SITREP will include OOH measures so the whole service can be reviewed through the SITREP process.

7.3 Daily Performance and Quality Calls (SITREP) During each of the first 7 days of the service the Clinical Lead, supported by the project team will chair a daily conference call at <time to be agreed> with the following participants: Present on this call should be:

Organisation Role

IC24 Operational representative from NHS 111 and OOH Clinical representative from NHS 111 and OOH

NEL CSU DoS Work-stream Lead

CCG’s and LCG NHS Norwich CCG Contract Manager Wisbech LCG Representative CCG Clinical Lead CCG Operations Lead However other CCG’s are welcome to attend if they desire

The purpose of the call will be to ensure the service is running smoothly. There will be:

Review of activity against plan

Review of KPIs

Review of system wide indicators for dispositions from NHS 111 service for: o Ambulance dispatches, o OOH referrals o ED volumes

Review performance of the OOH service e.g. o availability of OOH appointments, o number of Home Visits requested, o acuity of the OOH referrals

Review of incidents

Review of HPF

Review of complaints

Review of DoS issue

General discussion regards the service delivery overall <Structure of the call (to be agreed)

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After 7 days a decision will be taken regards the frequency of subsequent calls and will be very much dependent on the service performance and any issues being encountered

7.4 Operational Threshold Breaches To monitor the system over the initial weeks IC24 will take real time internal action to address increased demand or performance issues as per escalation plan. In the event of on-going reduced performance for a period of 3 consecutive hours below 85% or increased abandoned calls over 8%, IC24 111 on call would contact the coordinating commissioner to agree action to address.

7.5 Reporting to Area and National Team Should the service breach the 95% of calls answered in 60 seconds or more than 5% abandonment rate, the Coordinating Commissioner of NHS 111 and Primary Care OOH Contract Manager will submit an exception report to the Area Team on the National Template by 12.00pm (Monday to Friday). This will identify causes and action to be taken to address, by when.

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LIST OF APPENDICES Title Link

1) Programme Board Terms of Reference

NHS 111 and OOH

Mobilisation Programme Board Terms of Reference Final.docx

2) Clinical Governance Pack CG Pack here

3) DH Self-Assessment Checklist

4) Telephony Routing Meeting notes

5) Email from Wisbech confirming agreement to call routing

6) NHS 111 Matrix Functionality

7) IM&T Readiness Submission

DH Checklist -

N&W111.xlsx

Telephony Meeting

16.06.2015.docx

NHS 111 Systems

Functionality Matrix v3_1.pdf

NHS 111 IM&T

Readiness Submission - N&W111.doc.docx

8) CQC Registrations CQC registrations

9) Communications and Engagement Strategy

10) IC24 working Communications and Engagement Plan

111 and OOH

Comms Strategy FINAL VERSION.docx

Norfolk 111 OOHs

Working Comms and Engagement Project Plan v20 14 07 15.xlsx

11) Information Sharing Agreements ISA’s here EEAST MOU here

12) DoS Standard Operating Practice

DoS SOP here

13) Mobilisation Plan

Copy of Norfolk

111_OOH Mobilisation and Demobilisation Project Plan v10.xlsx