What is NHS Pathways?
What is Capacity Management System (CMS)?
Next Steps
Future Possibilities
NHS Pathways is all about improving the patient experience. It is a triage tool that can be used by ambulance service 999 call takers to differentiate the clinical skills needed to meet an incident and the timeliness of the response. The triage tool very quickly identifies life threatening situations and enables rapid dispatch of resources as they are now, but the key emphasis is on meeting the broader needs of the health community for the spectrum of calls received on 999, including the considerable proportion that do not require an ambulance response.
NHS Pathways has been developed in the UK by the NHS to fit with UK legislation on emergency and urgent care responses, and is recommended by the Joint Royal Colleges Ambulance Liaison Committee, GP and urgent care professional bodies and the British Medical Association. NHS Pathways has been developed to link into specific NHS services in the local area.
North East Ambulance Trust was the first Ambulance Trust to successfully pilot the NHS Pathways over two years ago, since then they have handled over two million calls through pathways with demonstrable benefit to patients and to the Trust in avoiding unnecessary journeys to Emergency Departments.
NHS Pathways has algorithms that allow for more "Hear and Treat" of less serious conditions or Category C calls and has detailed clinician led advice structures aligned to the NHS. The key benefit is that this approach offers patients integrated and more immediate care advice rather than attending an Emergency Department.
The NHS Pathways arrives at 'dispositions' which is a combination of symptoms along with social and domestic situation combined, rather than the conventional triage which arrives at a diagnosis. The output is that the disposition leads to a skill requirement e.g. for a catheter change and a timeliness which may be "within 4 hours", Timeliness may be affected by the patient's situation, e.g. are they outdoors? Is it cold or wet? Do they have another carer with them? This may escalate the response or even downgrade it if advice and self help is recommended. Diagnosis can sometimes be difficult to ascertain when there is a differential list of possible diagnoses for the symptom group.
South Western Ambulance Service NHS Trust is looking to adopt the NHS Pathways from Spring 2011.
One of the main drivers for the change in the triage tool, aside from the benefits above, is the integration with another piece of work, that has now been combined with NHS Pathways is the Capacity Management System (CMS).
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CMS is a web based application which can be viewed on almost any internet connection and over NHS net. It has password protection, but does not contain any patient identifiable information. The CMS has been in the NHS in various forms for over 12 years and many different parts of the country have adopted it to some extent. The current format is supported by Connecting for Health and is now fully integrated into the NHS Pathways product.
The CMS is made up of three key areas:
- Overall Hospital Activity (OHA) - pressure status and bed states for acute hospitals.
- Directory of Skills and Services (DoSS) - detailed capability and capacity information about every team and service across the health community.
- Community Bed Information - ward level capacity information in the community beds setting.
Overall Hospital Activity (OHA)
The Overall Hospital Activity Module presents the pressure status and bed states for acute hospitals, including their access points (A&E, EMU etc).
The advantage of having centrally held information on bed states and the pressure status is for planning, winter pressure plans and relieving very busy hospitals by redirecting patients if appropriate and for major incidents when there is an instant view of current bed capacity in the local NHS. Each provider updates their bed status several times a day; this is consistent with their current obligations for bed state reporting and situation reporting.
South Western Ambulance Service NHS Trust is working as the co-ordinating party with the Primary Care Trusts (PCTs) in Cornwall and Isles of Scilly, Devon, Dorset and Somerset areas to populate the CMS in time for the introduction of NHS Pathways as their telephone triage tool. Most of the PCTs are hoping to implement the Acute and Community Hospital bed states in time for winter, to facilitate their winter pressure situation reporting.
Directory of Skills and Services (DoSS)
The DoSS is a comprehensive database of community based services. It is a platform that will hold detailed capability and capacity information about every team and service across the health community. The CMS DoSS holds this data in a format that NHS Pathways can interrogate automatically - thereby presenting to call handling staff the best options for the patient.
The CMS can be accessed from the Related Links page.
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South Western Ambulance has identified that replacing the current triage tool in the clinical hub with the NHS Pathways and CMS is a great improvement for patients and the Trust alike. The patient experience will be a more robust version of what many think happens already, that services have visibility of each other under the banner of "the NHS" and that there is some connection.
There are increased patient benefits, in terms of quality of response from the NHS and this will grow as more services join the Directory of services, e.g. Dentists, ophthalmologists, pharmacists etc, and the patient experience will be more complete.
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During 2011 there will be an evaluation of the 111 single point of access projects that are about to get underway in the UK for patients who want non-life threatening health advice. As NHS Pathways is well supported by the Department of Health and other leading health professional bodies, it will almost certainly be a pre-requisite for any provider looking to host the 111 service for their region.
The use of NHS Pathways may also benefit the health service in other ways, some PCTs in the country use the same NHS Pathways triage tool to assess Out of Hours calls.
A future development of the NHS Pathways under consideration by the central development team is the development of a bedside module for paramedics to use in the field to improve their "See and Treat" aspect of care, which again will access local providers to support the patient and avoid taking them to the acute Trust.
These developments are currently beyond the scope of the Trust's plans but a consistent approach to routes for patient care will benefit patients and commissioners, and as the Health service looks for quality and productivity gains in the current financial climate there will be more interest in this kind of approach.
For more information on NHS Pathways and CMS please use the menu to the right to navigate the site.
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