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Myth buster

This information is intended to address some of the common misconceptions about the NHS Pathways programme.

Clinical myth busting with Dr Peter Fox

Welcome to this first set of clinical myth busting videos; we have put these together in light of several misconceptions about NHS Pathways that we have discovered when out in the field.

My team and I spend a lot of time talking and taking feedback from clinicians and staff from other services that could benefit from NHS Pathways, and recently we have encountered a series of 'facts' which are incorrect and we would like to set the record straight.

I would like to emphasise that these videos represent an ongoing dialogue with services out in the frontline, and if you disagree with any of our myth busters or just have any other questions or general comments to make, then we'd like to hear from you.

Got any other myths that need busting? Contact us at the address above.

Thanks for watching, and enjoy.

Myth 1 - You can't re-triage with NHS Pathways

Myth 2 - NHS Pathways is just a way to replace clinicians with cheap non-clinical call handlers

Myth 3 - Nurses are no longer needed because of NHS Pathways

Myth 4 - NHS Pathways is just a computer program developed without clinical input

Myth 5 - NHS Pathways creates more work for GPs

Myth 6 - NHS Pathways puts more pressure on primary care services

Myth 7 - NHS 111 and NHS Pathways are the same thing. You can't use one without the other

If you would like to embed them on your site, then head to our YouTube channel.

Other current myths

Myth: NHS Pathways requires a full system change.

Fact: This is incorrect, NHS Pathways is a clinical assessment tool that sits within a host system an organisation already had in place.  The technical specification to allow the embedding of the NHS Pathways content within a system is available to any supplier that wishes to sign the License.  No organisation has to change its infrastructure to enable access to NHS Pathways.

NHS Pathways does require careful mapping of revised workflow associated with enabling assessment and referral to definitive care for 80% of callers on first call (99.5% for 999 calls).

Myth: Call handlers only get two hours training before they use NHS Pathways.

Fact: Any call handler using NHS Pathways to answer calls undertakes a 60 hour training programme which includes a pre-course learning pack which provides an introduction to the system and key areas of anatomy, physiology and medical terminology, classroom tuition, written and practical assessments which must achieve a pass mark of 70%.

Additionally, all call handlers receive a minimum of four weeks of supervised use on the live system followed by another assessment. This includes a clinical audit of calls taken and direct feedback to the individual.

This is in addition to any training provided by the organisation on use of telephony, call control and local processes and procedures for call referral under different circumstances, such as child protection, vulnerable adult, frequent caller or patient with special notes.

Myth: The call length for NHS Pathways is longer than for other systems, meaning that patients have to wait on the phone longer.

Fact:  Comparisons of call length between different systems needs to compare the entire episode of calls within the organisation.  So if a call is opened by a call handler, and transferred to a nurse for completion then both call lengths need to considered.

In the 999 setting, more than 99.5% of calls are closed by the call taker, with between 15-20% of 999 calls referred to a non-ambulance disposition.  Accurate comparison with other 999 call handling systems need to include the call length associated with low priority calls placed in a queue for clinician ring-back and re triage to definitive care.

With NHS Pathways, in an urgent care environment, around 80% of calls are opened and completed by the call handler, with an average call length of between 5-7 minutes.  Some of the variation comes from how NHS Pathways has been embedded within the host system and the implications for call flow, and operational system use for call length.

Myth: Integrated care pathways and NHS Pathways – are they the same thing?

Fact: No, integrated care pathways are treatment paths for patients with particular conditions or illnesses, which mostly take place in a secondary care environment.
NHS Pathways assesses symptoms reported over the phone (e.g. 999 or 111 calls) by the patient in a one-off exchange and gives them the best course of action at the time.  Patients may enter an integrated care pathway after their interaction with NHS Pathways and when they access primary or acute care services for treatment.

Myth: The Capacity Management System (CMS) is just a Directory of Services.

Fact: The Directory of Services (DOS) is just one module in the CMS suite.

There are additional modules including:

  • Overall Hospital Activity – an indicator which takes data from points within an acute or community unit and provides a score of relative 'busy-ness', which allows commissioners and winter/emergency planners to review relative capacity across an area at a glance.
  • Critical Care Bed Status – a web-accessible record of the critical care beds available in Critical Care Units across England.  This supports clinicians to locate an available bed and make fewer phone calls to seek a vacancy into which a patient can be referred.
  • Paediatric Critical Care Status – as above but for paediatric critical care beds.
  • 999 rerouting.

Myth: Call handling data, case records and triage records do not need to be provided to the central NHS Pathways team once ownership of CQI (continuous quality improvement) has been transferred to an NHS organisation.

Fact: This is not true; the License to use NHS Pathways which is signed by any organisation using NHS Pathways to deliver NHS commissioned services requires provision of specified data on a monthly basis as an essential part of system performance monitoring for the central team across the board.  This helps inform improvements to future releases of NHS Pathways. This data should be sent to the central team for the lifetime of the NHS Pathways clinical content within your host system.

Myth:  You have to answer all of the questions, every time even when you know what the patient has rung about.  You cannot quickly get to the relevant questions for 'cough' without asking lots of unnecessary questions about gun-shot wounds.

Fact:  NHS Pathways clinical structure has been very carefully set to maximise clinical safety and operational appropriateness.  The initial questions support identification of life threatening conditions, but all call handlers are taught that they must answer every question but they do not have to ask every question.  For example:  if a caller is ringing about their cough and is quite clear that is the only issue they have, and is talking normally, it is possible click through screens asking about life threatening haemorrhage and arrive at the Body Map, where the symptom specific selection can be made to support speedy triage of the reported cough.

Myth: NHS Pathways and the Directory of Services (DOS) are separate products and the DOS can be used with any other triage software.

Fact: They are two separate products but work best when integrated with one another.  The Clinical data within the DOS can only be searched automatically when it is integrated with Pathways, otherwise the DOS must be search manually by a clinician, either directly, or via a clinician instructing a call taker on the clinical search parameters to be manually entered.

NHS Pathways with the integrated DOS is the only tool that provides a fully integrated clinical assessment and referral. Both products are owned by the Department of Health and no other triage software can link to the clinical data within the DOS in the same way that NHS Pathways does.

Myth: Alternative providers have a proven shorter call times and lower numbers of referral to ambulances for NHS 111 calls.

Fact: Only NHS Pathways is being used to assess live NHS 111 calls. To date, DH has not accredited any other systems and until live pilots have been implemented and the data evaluated it is not possible to compare alternative system data with existing NHS 111 pilots with any accuracy.

Not every aspect of NHS Pathways is covered, so if you have additional issues you would like to address please email the team.