Chamber and committees

Along with patient/caller complaints, commentsand compliments, this feedback mechanism forms part of NHS 24’s robust and thoroughquality improvement and performance management programme, which ensures that callsand patient records are reviewed as part of any investigation. On-going trainingand development requirements for each individual member of staff are included inthe resource requirements of the service.

All frontline staff are supported by an individualProfessional Development Plan, regular call consultation reviews and robust supportand supervision by their team leader. All learning, including that from partnerand patient comments, complaints and compliments, is fed back both to the individualand into the organisation. This includes the examples of best practice that areroutinely highlighted by call and consultation review.

NHS 24’s nurses are not asked to make a diagnosisof a caller’s symptoms – their clinical assessment determines the best next stepin a patient’s care, primarily during the out-of-hours period when GP practicesare closed. This may be self-care advice, to allow the patient to look after themselvesat home without the need to be referred to another part of the service; it may bethat the patient is asked to attend a local Primary Care Emergency Centre to seea doctor or nurse face-to-face; a GP home visit may also be arranged – these outcomesare based on clinical need. Details of contacts with out-of-hours services are thensent to the patient’s own GP practice the next working day, for follow-up if requiredand for information.

NHS 24’s outcomes direct patients to the mostappropriate care setting – as do those of the Scottish Ambulance Service. NHS 24’snurses use a computer-based system as a support tool and they are encouraged toexercise their own clinical judgment to determine the most appropriate outcome forpatients. Both services differentiate between local Minor Injury Units (MIUs) andAccident and Emergency departments and will arrange attendance at the most appropriateplace for the individual’s clinical needs. Varying levels of service may be providedin different locations, and this is managed by local NHS boards.

It is important to remember that,for immediately life-threatening conditions, people should always call 999 for anemergency ambulance. NHS 24 can, however, transfer calls to the Scottish AmbulanceService if an ambulance is required – it is then up to the ambulance crew wherethey take the patient, based on their own assessment of the patient’s needs.

The continuation or closureof existing programmes of the New Opportunities Fund is a matter for the fund.Ministers set the strategic framework for lottery bodies, but operationalmatters and programme design are a matter for the lottery distributorsthemselves.