Monitoring questions for urgent care services, including NHS 111 and GP out-of-hours services

• How do you ensure staff recognise safeguarding issues for adults, children and other vulnerable people, and that they take appropriate action?
• How do you ensure that the management of any safeguarding concerns does not discriminate people, and that their human rights are protected?
• What are your arrangements to respond to medical emergencies?

Infection control

• What changes have you made to infection control arrangements to protect staff and patients using the service?
• How do you ensure staff have the appropriate time for donning/doffing and cleaning between seeing patients? (not relevant to online services)
• When was your last audit of IPC/PPE/the environment and facilities? What did it tell you and what actions have you taken?

Safety systems and risks to people

• What actions have you taken in the last six months as a result of learning from serious incidents to ensure people are kept safe?
• How are patients who need urgent care and treatment identified, prioritised and protected from discrimination?
• How do you recognise and manage the deteriorating patient? (not relevant to online services)
• How do you ensure appropriate staffing levels and skill mix to cope with demand? (For example, weekends, bank holidays, seasonal pressures, epidemics)
• Urgent care: What are your systems to support staff to work remotely where this is appropriate and required?
• Urgent care: How are you managing demand safely to avoid long queues where patients walk in?
• Urgent care and NHS 111: If you have had to relocate any part of the service, how have you managed the impact on staff/equipment and how have you communicated changes to people who use the service?
• NHS 111: Are staff clear about the arrangements for diverting calls? Do staff have the appropriate technology to support this process?
• NHS 111: If hotdesking, what are your arrangements to ensure staff adhere to IPC guidance and have access to appropriate cleaning materials? (for example, wipes for computer station)

• How do you manage clinical records to ensure safe care and treatment?
• How do you manage referrals to and from other providers? (not relevant for online providers)

• Have you made any changes to your approach to medicines management? (for example, in relation to repeat prescribing, ongoing monitoring requirements for high risk medicines)
  • If so, what and how has this affected care?
• How are people’s medicines reconciled, in line with current national guidance, when transferring between locations or changing levels of care?

• How are you identifying, cascading and keeping up to date with changes in clinical guidance?
• What are your oversight arrangements for clinical care provided by clinical and non-clinical staff?
  • to people in care homes
  • to vulnerable people in their own homes (Out-of-hours)
  • for clinical decisions made during calls (NHS 111: including closing cases at the appropriate time)
  • Urgent care, out-of-hours and NHS 111: How are you keeping up to date with NHS Pathways and Clinical Decision Support System (CDSS) updates, and ensuring all staff are aware?
  • NHS 111: How does the Directory of Services reflect any adjustments to services?

• How do you ensure that all staff (clinical and non-clinical), including those being flexibly re-deployed, have the skills and knowledge to carry out their roles and responsibilities effectively?
  • How do you ensure that the staff who deal with patients are operating within the appropriate scope of practice at the point of recruitment, and ongoing? For example, audit of consultations?
  • Urgent care, NHS 111 (including 111 First), out-of-hours:How do you ensure all relevant staff (including call-handlers) have the knowledge and confidence to make appropriate clinical decisions when triaging/assessing patients?

• How do you ensure that people who are affected by health inequalities are receiving the care they need?
• How are you promoting good health/targeted approaches in response to coronavirus (COVID-19) and people at risk?

• How have you adapted how you support and engage with patients and their families/loved ones (for example, in the context of more remote working)?

• How do you support people to express their views and actively involve them to make decisions as far as possible?
• NHS 111: How do you support people to make informed decisions about services they need to access?

• How do you take into account patient choice about how, when, where they want to be seen? (not relevant to online services)
• How do you ensure that people with information and communication needs are able to access appointments and services in ways that meet their needs?
• How does care provision take account of the needs of individual people? (for example, Trans people, people who have a disability, people with long term conditions or mental health needs)
• Have you identified any barriers to care provision, particularly for patients with protected characteristics? For example, disabled people, older people, different ethnic groups. If yes, what actions have been taken to combat them?
• NHS 111 online: How do you engage with patients who are unable to use the telephone or digital/online platforms, so that you can understand their health needs and offer them care or treatment?

• How are you managing access to services?
  • Do you have backlogs of activity and long waiting times as a result of coronavirus? How are you managing this? What are your recovery plans?
  • How are you ensuring that high-risk/vulnerable patients and pathways are being identified and prioritised appropriately? (not relevant to online services)
  • What are your arrangements to follow-up and support patients whose care and treatment was delayed due to coronavirus? For example, patients with non- coronavirus related issues.
  • How are you ensuring equitable access to appointments when they are needed, especially for people with protected characteristics and vulnerable groups? For example, Trans people, people who are housebound, people at the end of their life. (not relevant to online services)
  • Urgent care, out-of-hours: How is the service working with partners to maintain and improve access? (for example, PCN, third-party providers, carer services, local services such as ambulance service etc)
  • NHS 111, out-of-hours: What are your arrangements for clinician call-backs (including online and video) i.e. specified time/date offered to patient? How do you ensure patients are not missed or lost through this arrangement?

• What actions are you taking to protect and support the health, safety and wellbeing of staff, particularly those who are high-risk/staff in different ethnic groups? For example, coronavirus testing
• How do you promote equality and diversity, and check that staff feel supported, respected and valued?
• What training and support is available for staff using new technology to deliver care? (not relevant to online services)
• Urgent care, NHS 111, out-of-hours: How are you supporting staff who work remotely and how are you assessing them?

• Has your business model/operating model changed since the pandemic? If so, how and what has been the impact on staff and people who use your services?
• How do you assure yourself that you are providing a safe service? For example, regular audits and increased supervision etc.
• How are you monitoring business risks and issues, and what actions are you taking to respond to them?
  • What are the arrangements for business continuity? For example, arrangements for diverting calls, contingency planning for staff shortages/ outbreak onsite, changes made in light of coronavirus. How are you flexing the service/models of care to adapt to changing circumstances, including second wave of coronavirus?
  • How are you working with partners to review and update local pathways?
  • NHS 111: How are you working with partners to understand any changes to their services/models, and ensure your service is aligned? For example: ambulance service, local GP practices, local A&E departments, out-of-hours
  • Urgent care, NHS 111, out-of-hours: How do you ensure oversight and governance of care provided by external staff who are working with your patients? For example, staff employed by PCN or third-party provider?

• What systems are in place to support people (staff/people who use your services and their families/carers) to speak up and raise concerns?
• How do you support people to provide feedback?
• Urgent care, NHS 111, out-of-hours: How do you share complaints/feedback with relevant partners to facilitate learning across the local system? For example, ambulance service, local A&E departments, out-of-hours, urgent treatment centres, NHS 111.