NHS Pathways - leading the way to better care for patients

Since the North East Ambulance Service (NEAS) went live in October 2006 with NHS Pathways and the Directory of Services they have seen in the region of 2000 inappropriate ambulance journeys being avoided each month with A&E ambulance crews being better diverted to more serious and life-threatening emergencies.

There has been an increase in ambulance services across England keen to know more and implement NHS Pathways and the Directory of Services into their 999 control rooms. This year three more ambulance trusts have gone live with NHS Pathways and the Directory of Services in their 999 control rooms. These include the South East Coast Ambulance Service NHS Foundation Trust and the Isle of Wight Ambulance Service.

NHS Pathways is a tool developed by the NHS which is used to identify the best service and how quickly a patient needs to be treated, based on their symptoms. NHS Pathways works by enabling a specially designed clinical assessment to be carried out by the call handler, once this is completed a clinical skill set and a defined timescale will be identified for the patient. As the assessment tool supports 'hear and treat' this enables call handlers to refer the caller to primary care on the first point of contact (if an ambulance is not required) and avoids the need for a separate queue of calls, waiting to be re-triaged by a separate system.

NHS Pathways includes over 700 symptom based clinical assessment flows and its implementation will improve the clinical triage given to patient, avoiding unnecessary responses and conveyances to hospital, which will in turn assist ambulance services achieving their response targets.

All questions asked need to be answered as they are used to ensure the patient is directed to the right service first time. Types of service may include, an ambulance response, advice to contact own GP or the out of hours service, visit the local minor injury unit or walk in centre or home care.

NHS Pathways and the Directory of Services has helped to develop the way in which urgent and emergency care can be integrated with primary care services in any area. The system has brought about a more holistic view of urgent and emergency healthcare and is ensuring that patients receive a more direct route to the services that they require.

The South East Coast Ambulance Service NHS Foundation Trust, which implemented NHS Pathways in April, is already seeing the benefits with an immediate improvement in the number of patients receiving more appropriate treatment in primary care, freeing up its ambulances to respond to more serious and potentially life-threatening emergencies. One Saturday over the bank holiday weekend in April, one of the three 999 control rooms received 300 calls, of which 80 were referred into primary care such as urgent care centres, walk in centres, an out of hours GP etc.

Dan Garratt, Distribution Development Manager, who was involved with the Trust's implementation of NHS Pathways, said: "Introducing NHS Pathways into our three control rooms has made a significant difference to the way in which we're able to manage 999 calls. Having the ability to refer patients on to the right healthcare for their need during that initial call with the support of a directory of services is a significant leap forward for patient care.

"We know that many patients find navigating around the NHS difficult and this new system allows us to help patients on that journey, while freeing up emergency ambulance crews to respond to more life-threatening emergencies. Patients who do not require an ambulance can be referred to the most appropriate service in primary care."

South East Coast Ambulance Service is the third large ambulance trust to go live with NHS Pathways in its 999 control rooms. The South East Coast covers a diverse geographical area of 3,500 square miles and in 2009/10 it received more than 619,000 emergency calls from members of the public or other healthcare professionals - that's roughly one call every minute. So, having the assessment tool in place has enabled the service to better support patients receive the right for the their needs and deliver a more responsive service to those more seriously ill or injured patients who need the face to face clinical expertise of its A&E ambulance clinicians.
NHS Pathways also supports the Government's plans to modernise the NHS, set out in the White Paper Equity and Excellence: Liberating the NHS. Two of its main focuses are; putting patients and public first and improving healthcare outcomes, and this assessment tool aims to support both of these. This has already been seen with NHS Pathways and the Directory of Services underpinning the NHS 111 pathfinders. NHS 111 is the new urgent care number for patients to call and works alongside 999. The key message for the public is if it's an emergency call 999 and if you have an urgent care need or are unsure who to call dial 111. As NHS 111 sites are interlinked, if the patient requires an emergency ambulance one can dispatched without delay. Currently, NHS 111 is only available in four areas, the next phase of NHS 111 sites will also be using NHS Pathways and the Directory of Services as their primary clinical assessment and referral tool.

This year NHS Pathways has also expanded its deployment within out-of-hours services, Derbyshire Health United and South East Health who are using NHS Pathways to triage out of hours calls, and to deliver the Warwickshire 24/7 urgent care access number.