My understanding is that 2-3% of calls to NHSD are directed to the ambulance
service. NHSD do not dispatch ambulances. The ambulance service makes it's
own assessment of the call and responds as appropriate. I have no
information on the number of times an ambulance is dispatched following an
NHSD referral but the patient is not transported to hospital - estimates
generally are 25-30% patients not transported across all "999" calls and
not just those referred by NHSD.
Obviously the ambulance service can feed back any concerns using the same
"blue form" system A&E departments should use.
Mike Lambert
> -----Original Message-----
> From: Stuart Pinborough [SMTP:[log in to unmask]]
> Sent: 23 February 2001 17:26
> To: [log in to unmask]
> Subject: Re: NHS Direct
>
> Sorry Mike I don't think NHSD bashing is fun. I wonder if any one has
> audited the amount of callers who are sent an ambulance by NHSD and are
> actually conveyed to hospital.
> ----- Original Message -----
> From: "LAMBERT MIKE (RM1) Norfolk and Norwich NHS Trust"
> <[log in to unmask]>
> To: <[log in to unmask]>
> Sent: Friday, February 23, 2001 4:44 PM
> Subject: Re: NHS Direct
>
>
> > -----Original Message-----
> > From: Stuart Pinborough [SMTP:[log in to unmask]]
> > Sent: 23 February 2001 15:23
> > To: [log in to unmask]
> > Subject: NHS Direct
> >
> > I was under the impression that NHSD send an Ambulance for most of their
> > callers, it saves them having to make a decision.
> >
> >
> > I realise NHS Direct bashing is fun, but in view of this and other
> recent
> > contributions about NHS Direct I thought a few facts and comments might
> be
> > appropriate
> >
> > I represent BAEM on the NHS Direct National Clinical Reference Group,
> and
> > before anyone asks - no I wasn't one of the A+ merit award holders (I
> wish!)
> > that Danny blames for the whole idea.
> >
> > At a recent meeting of the CRG the following, among other things, were
> > discussed...
> >
> > * Data was presented to show how the new NHS Direct (NHSD)
> software
> > (AXA) is performing. Currently the national average is 9% of all calls
> > referred to A & E. This compares to 45% referred to primary care. My
> > recollection is that 40% are refereed to self care and only 2-3% to
> "999".
> > The reminder are referred to other agencies like pharmacy, health
> visitor
> > etc.The average length of each call is currently 11 minutes.
> > * Where NHSD sites have recently gone live or have had to change
> from
> > other IT systems to the new AXA system it was reported that the
> algorithms
> > tend to sort "high" i.e. more likely to refer to A & E than GP, and that
> > calls take longer. It is anticipated that as staff become more familiar
> > with the newer algorithms that dispositions will become less acute.
> > * NHSD relies very heavily on feedback to identify appropriate and
> > inappropriate dispositions and referrals. It is essential that all A &
> E
> > Departments familiarise themselves with local arrangements to feedback
> > concerns about the working of NHSD. Currently this is done through a
> "blue
> > form" system. Forms should be available in every A&E Department.
> >
> > Also, BAEM has been asked to work with NHSD to review and develop all
> the
> > algorithms currently in use. The Exec will discuss all these issues in
> > March.
> >
> > If anyone has specific factual concerns about how NHSD is working in
> > relation to their department or service I suggest you raise the issue -
> > using the blue feedback forms - with the Medical Director for your local
> > NHSD site or via your local clinical steering group (if you can't
> identify
> > these people let me know and I will find out for you). Concerns will be
> > investigated, usually including review of the algorithm and a recording
> of
> > the call. If you find you are not getting a satisfactory response please
> let
> > me know and I will take it up with the national development team. The
> > algorithms and the skills of the call takers and nurse advisors can only
> > improve if we contribute appropriate feedback.
> >
> > The national development team will work with the CRG to define
> performance
> > indicators and datasets which will improve analysis and understanding of
> the
> > contribution NHSD is making to the NHS as a whole. Any suggestions about
> > information and regular reports you, as a specialty or an individual
> > department, would like to receive about NHSD performance and activities
> > would be welcome.
> >
> > NHS Direct - and developments such as the Clinical Advisory and
> Management
> > System - will be an integral part of future health care provision. BAEM
> has
> > recognised that while NHSD has it's critics and is not perfect, it has
> the
> > potential to make a significant contribution to the future delivery of
> > emergency, and other, health care. The Association is working to make
> the
> > relationship between BAEM, A&E departments and NHS Direct as
> constructive
> > and positive as possible.
> >
> > Surely it is better to be actively involved and work with NHSD to help
> the
> > system improve, than to use anecdote and ill-informed comment to
> criticise
> > and so risk being side-lined in future emergency health care
> developments.
> >
> > Apologies for the long post, but I had to get that off my chest. I will
> now
> > sit back and await the abuse and brickbats!
> >
> > Mike Lambert
> > Norwich.
> >
> >
> >
> >
> >
> >
> >
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