Policy for the Management of Patients with Defined

East of England Ambulance Service

NHS Trust

#WeAreEEAST *

Policy for the Management of Patients with Defined Individual

Needs

Document Reference: POL038

Document Status: Approved

Version: V3.0

DOCUMENT CHANGE HISTORY

Initiated by Date Author (s)

Trust requirement

November 2015 Compliance and Standards Lead

www.eastamb.nhs.uk

www.eastamb.nhs.uk

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Management of Patients with Defined Individual Needs

Version Date

Comments (i.e. viewed, or reviewed,

amended approved by person or

committee)

Approved V1.0

5th December 2017

Equality Impact Assessment Stage 1 approved at ELB

Draft V1.1 08/05/2017 Original reviewed

Draft V 1.2 26/07/2017 Amendment completed

Draft V 1.3 25/09/2017 Revised draft – ARP changes

Draft V 1.4 09/10/2017 Safeguarding Team comments

Draft V 1.5 16/10/2017 Clinical review

Draft V 1.6 12/10/2015 Equality Impact Assessment – Stage 1 – Initial Screening

Draft V 1.7 16/10/2017 Final comments prior to CQSG

Draft V 1.8 Approved by CQSG subject to formatting with new corporate template

Approved 2.0 Approved by ELB

Draft V2.1 01/08/2019 Introduction of new stage

Draft V2.2 12/09/2019 Approved CQSG

Approved 3.0 31 October 2019 Approved by Management Assurance Group

2 POL038 Management of Patients with Defined individual Needs

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Document Reference Health and Social Care Act 2008 (Regulated Activates) Regulations 2014

Recommended at Date

Clinical Quality & Safety Group 21st December 2017

Approved at Date

Management Assurance Group 31 October 2019

Review date of approved document

31 October 2021

Equality Analysis Completed [11/12/2017)]

Linked procedural documents

Computer Aid Dispatch (CAD) Markers Policy Safeguarding Vulnerable Adults Policy Safeguarding Vulnerable Children & Young Peoples Policy

Dissemination requirements

All managers and staff via email and intranet. To be published on the Trust’s public web site

Part of Trust’s publication scheme

Yes

The East of England Ambulance Service NHS Trust has made every effort to ensure this policy does not have the effect of unlawful discrimination on the grounds of the protected characteristics of: age, disability, gender reassignment, race, religion/belief, gender, sexual orientation, marriage/civil partnership, pregnancy/maternity. The Trust will not tolerate unfair discrimination on the basis of spent criminal convictions, Trade Union membership or non-membership. In addition, the Trust will have due regard to advancing equality of opportunity between people from different groups and foster good relations between people from different groups. This policy applies to all individuals working at all levels and grades


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for the Trust, including senior managers, officers, directors, non-executive directors, employees (whether permanent, fixed-term or temporary), consultants, governors, contractors, trainees, seconded staff, homeworkers, casual workers and agency staff, volunteers, interns, agents, sponsors, or any other person associated with the Trust.

All Trust policies can be provided in alternative formats


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Contents

Page Paragraph Introduction 81.

2. Purpose 9

3.

Definitions 11

Duties 9

4.

5. Development 11

6. Identification of Patients with Individual 12 Needs

7. Managing Frequent and Complex Callers 13

8. Management Process of Frequent Callers <18 14 years

9. Management Process of Frequent Callers >18 15 years

10. Management of Patients with Complex 22 Medical Needs

11. Multidisciplinary Working 22

12. Information Sharing 24

13. Process for Monitoring Compliance and 24 Effectiveness

14. Standards / Key Performance Indicators 25

25 15. Associated Documents


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Page Paragraph

Appendices

Appendix Frequent Caller Management <18 Years Flow 26 A Chart

Appendix Frequent Caller Management >18 Years Flow 27 B Chart

Appendix Frequent Caller Information Process 28 C

Appendix EOC Frequent Caller Process 29 D

Appendix Patient with complex Medical Needs 31 E Management Flow Chart

Appendix F Standard Letter to GP 33


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1. Introduction East of England Ambulance Service (EEAST) is committed to providing a patient- centred and clinically appropriate service to the patients it serves, ensuring the right response to the right person at the right time.

A wide range of people rely on the 999 service we provide for an emergency response to serious and life threatening conditions. The majority of patients can be treated with the principles and practices of assessment and care that are laid down in core training.

There are, however, a group of service users who use the 999 emergency service significantly more frequently than others, when they might benefit from an alternative pathway of care and this can have a significant impact on EEAST resources, both within the Emergency Operations Centre (EOC) and in operations.

Some patients will have conditions that require assessment and treatment that is unfamiliar to ambulance personnel.

There may be new guidance on specific treatment for certain conditions that require a specific reminder to crews to ensure that best practice is adhered to.

The patients concerned may:

- Have a long term condition with an acute exacerbation or require support to manage their condition appropriately at home.

- Be experiencing a specific episode of ill-health or difficulty. - Also have unmet social or healthcare needs and alcohol, substance or

mental health related healthcare issues. - Be unaware of more appropriate entry points into the NHS.

Not all of these callers require an emergency response from a qualified clinician. They may call a substantial number of times per 24 hour period, involving call handlers, the Emergency Clinical Advice and Triage Centre (ECAT) and emergency responders.

This Policy outlines the ways in which EEAST can determine, agree and mobilise appropriate alternative care pathways for people calling 999 regularly, frequently or with very specific and defined needs that may not be covered in core training.


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2. Purpose 2.1 Strategic aims The aim of this Policy is to create a consistent and clinically appropriate approach to managing and supporting people who use our service and would benefit from having an individual management plan to meet their specific health and social care needs.

2.2 Objectives The objectives of the Policy are to:

Achieve an appropriate care pathway for all service users however complex their care needs are, by:

- Defining an agreed process for identifying such callers - Developing appropriate alternative pathways of care/care plans for these

callers. - Creating a local multidisciplinary approach to managing identified

patients involving local health and social care providers and commissioners.

- Tracking callers and identifying such callers that may be vulnerable or have a safeguarding concern and to inform a multi-agency team regarding alternative support.

3. Duties 3.1 Director of Nursing and Cl inical Quality The Director of Nursing and Clinical Quality has delegated responsibility for managing the strategic development and implementation of organisational risk management, clinical effectiveness and clinical governance and is the Board Safeguarding Champion.

3.2 Deputy Medical Director The Deputy Medical Director has delegated responsibility for the management of clinical standards. They are also responsible for the national clinical performance indicators, pre-hospital clinical care and research. The Deputy Medical Director has overall responsibility for the individual management plans agreed within the scope of this policy. 3.3 Operational and Clinical Staff Operational and clinical staff have responsibility for identifying and reporting


3.8.1 Clinical Quality Safety Group (CQSG)

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potential patients that would benefit from an individual management plan and fulfilling any care plans developed in respect of individual patients.

3.4 Frequent Caller Lead The Frequent Caller Lead is responsible for the management of frequent callers within EEAST. They will meet with the Deputy Medical Director and EOC Clinical Lead bi-monthly to review frequent callers and manage frequent callers in line with this policy. They will also be responsible for delegating roles in line with this policy, attend meetings and manage frequent callers within the scope of this policy.

3.5 Emergency Operations Centre The Emergency Operations Centre (EOC) has responsibility for day to day call handling and dispatch for these patients within the scope of this policy.

3.6 Safeguarding Team The Safeguarding Team is responsible in conjunction with the Clinical Coordinator team for the identification of whether the needs of the child/young person are clinical or safeguarding and identification of an appropriate pathway.

3.7 Clinical Coordinators The Clinical Coordinator team are responsible for the clinical assessment/management of these patients at the point of call within the scope of this policy and for the implementation of this policy.

3.8 Committee Structure

The Clinical Quality Safety Group (CQSG) will review the clinical activity provided by the Trust and ensure that all underlying processes fully support staff to provide high quality patient care. This includes clinical effectiveness, safeguarding children and adults, clinical audit and clinical standards. The CQSG will monitor and report clinical issues and risks in relation to this Policy to the Patient Safety and Clinical Quality Committee. CQSG will provide assurance that service provision which impacts on the patient’s experience is monitored so action can be taken as and when necessary to improve the standard of patient care and reduce clinical risk.


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4.0 Definitions For the purposes of this Policy, a person may be defined as using the service regularly or frequently if they call:

• Children < 18 years: 3 or more times within a 6 month rolling period. • Adults > 18 Years:

- 5 or times in a month period - 12 or more calls in a 3 month period - 15 or more calls in a 1 month period from a communal address For the

purposes of this Policy, a person may be defined as having complex care needs if;

• Their condition is such that the provision of specific information may materially alter the care pathway for that patient. • The provision of specific care information will ensure that the patient receives treatment in line with the most recent guidance and best practice (that may not have been covered off in training updates).

5.0 Development 5.1 Prioritisation of Work A wide range of people rely on the 999 service we provide for an emergency response to serious and life threatening conditions. The majority of patients can be treated with the principles and practices of assessment and care that are laid down in core training. There are, however, a group of service users who use the 999 emergency service more frequently or regularly than others, when they might benefit from an alternative pathway of care and this can have a significant impact on EEAST resources, both within the EOC and in operations. This policy has been developed to ensure these patients are appropriately managed.

5.2 Identification of Stakeholders The stakeholders identified as being affected by this policy are as follows; • Patients • Trust Staff – EOC & Operational • Safeguarding Team • Other Health Care Professionals


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• NHS Professionals

6.0 Identification of Patients with Individual Needs 6.1 Identification of Frequent callers Callers can be flagged as frequent callers though:

- A report on Portal, identifying frequent callers by Clinical Commissioning Group (CCG) areas

- Individual Name, Date of Birth, Gender and Address identified from PCR (Patient Care Record) reports.

- Contact with other agencies or providers, from both internal and external incident groups (Datix, operational crews, call handlers, ECAT Clinicians etc.),from other work streams or through the Trusts Patient Advice & Liaison Service (PALS) and safeguarding team.

Frequent Callers <18 years can be identified by the Frequent Caller Lead and Clinical Coordinator team using the Portal reports system reports or from internal and external referrals which includes the safeguarding team.

A group including the safeguarding team and other associate trust staff that will review a report that has identified frequent callers <18 yrs on a regular basis yet to be determined. The criteria is:

- <18 years by individual name and address >3 calls in a 6 monthly rolling period

Frequent Callers >18 years can be identified by the Frequent Caller Lead and the Clinical Coordinator team using the Portal reports system reports or from internal and external referrals.

- >18 years, by individual address 5 or more calls (individual episodes of care) in a 1 month period.

- >18 years, by individual address 12 or more calls (individual episodes of care) in a 3 month period

- >18 years, by communal address 15 or more calls in a 1 month period.

6.2 Identification of P atients with Complex Medical Needs


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Patients with complex medical needs will primarily be notified to the Trust through contact from the patients GP or specialist on an individual basis.

A small number of patients may communicate directly with the Trust about their clinical condition. The accuracy of the information provided will need to be triangulated with either primary or secondary care professionals.

There are some groups of patients with a specific condition whose care is coordinated through specialist clinics and the Trust may receive information on the whole group of patients.

Additionally, patients with complex clinical needs may be identified through contact with other agencies or providers, from both internal and external incident groups (Datix), from other work streams or through the Trusts Patient Advice & Liaison Service (PALS) plus the safeguarding team.

7.0 Managing Frequent and Complex Callers 7.1 Management of Frequent Callers <18 years:

- The Safeguarding team will review identified patients against existing Trust Safeguarding databases. - Where a safeguarding concern has already been raised, this will be reviewed and appropriately managed by the Clinical Coordinator, Frequent Caller Lead and Safeguarding team. -New patients will be reviewed for further management as appropriate.

7.2 Management of Frequent Callers >18 years: - Individual patients identified by the Clinical Coordinator team/Frequent Caller Lead - A safeguarding referral for newly identified patients will be raised via SPOC and the Clinical Coordinator Team/Frequent Caller Lead will review in line with current Safeguarding procedures.

The Clinical Coordinator Team/Frequent Caller Lead will coordinate initial registration and review of patients with complex medical needs in their geographical area of cover.


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7.3 Safeguarding Team Review Process: Management of all Frequent Callers <18 years:

- The report will identify these patients. - The Safeguarding team, Frequent Caller Lead and Clinical Coordinator

Team will review the data at the quarterly meetings, including chief complaint, and a decision made as to whether the child/young person’s needs are of a clinical or safeguarding nature.

- All children/young persons will be managed jointly by the Safeguarding team, Frequent Caller Lead and Clinical Coordinator Teams.

Management of Frequent Callers >18 years: - The Clinical Coordinator Team/Frequent Caller Lead will review all

Safeguarding referrals which have been made via SPOC by the ECAT Assistants, as appropriate, in line with Safeguarding procedure, and will highlight any concerns to the Safeguarding Team.

All recommendations from any Serious Adult Reviews (SAR) or Serious Case Reviews (SCR) will be reviewed and taken in to consideration.

7.4 Clinical Coordinator Team Process: The Clinical Coordinator Team/Frequent Caller Lead can liaise with the local named Duty Locality Officer, HALO or named Champion to review the individual patient.

The ECAT Assistants will assist the Clinical Coordinator Team/Frequent Caller Lead in the implementation of this policy.

8.0 Management Process of Frequent Callers <18 years 8.1 Management Process A report produced will identify all <18’s that have had contact with the Ambulance Service 3 or more times over a 6 month rolling period. All <18’s which have been identified in the previous quarter report, with no new calls, will be omitted from the report. This report will be reviewed by the Safeguarding team, Frequent Caller Lead and Clinical Coordinator Team at the


Tier Call volume Over 3 months

Min Max

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quarterly meetings to identify if the contacts with the Ambulance Service are for a clear medical condition or if there are any potential safeguarding concerns.

8.2 <18’s with Medical Co nditions All patients identified with a clear medical condition or need, will be passed to the Clinical Coordinator Team/Frequent Caller Lead/ EOC Clinical Lead for further review, assessment and appropriate action as necessary.

8.3 <18’s with Safeguarding Concerns The Safeguarding Team will support where there is a Safeguarding concern; a Child Social Care referral will then be made via SPOC in accordance with the Safeguarding of Children & Young Persons Policy, for further review and assessment by the Local Authority and copied to the child’s GP Surgery.

8.4 <18’s which require further i nformation and assessment. For those <18’s where there is no Safeguarding concern and no clear medical condition, a letter will be sent out to the patients GP Surgery or appropriate Health Care Professional (HCP), by the Clinical Coordinator Team, alerting them to the reason of contact with the Ambulance Service by the child/young person, for further review and assessment by the GP.

9.0 Management Process of Frequent Callers >18 years All contacts with the patient will be reviewed and an “event history” compiled which will be stored on the Datix system. This review, where appropriate, can include the Safeguarding Team, local Operational teams and other Health Care Providers.

Following a review of the individual need the Clinical Coordinator Team/Frequent Caller Lead will be responsible for liaising appropriately with Trust teams in line with the process as identified below.

9.1 Stage One (Frequent Caller – Low level activity) Once identified all frequent callers will be categorised into a coloured, tiered system. The tier will be based on call volume and will be as follows:


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Green 5 15 Amber 16 24

Red 25 49 Black 50 +

This tiered system will allow the frequent caller team to prioritise workload. For the green tier patient, the frequent caller team will send out a ‘Green Tier’ advisory letter along with the ‘choose well’ leaflet to the patient. The team will also send a letter to the frequent callers GP advising of the interaction with the ambulance service. These letters will encourage both the frequent caller and the GP to arrange a face to face meeting to assess the frequent caller’s current health needs. Green tier frequent callers will then have their activity reviewed three months after this initial letter is sent. If after 3 months the volume of calls has increased, and the criteria is still met for a frequent caller then a management plan will be implemented (as per stage two below).

9.2 Stage Two (Frequent Caller – Inappropriate use of t he service) Trust representative (Clinical Coordinator/Frequent Caller Lead/Duty Locality Officer) liaises with appropriate Healthcare Professional (GP/Community Service), discussing the patient’s activity and health & social needs through a letter, telephone contact or face to face meeting. Acknowledgment is sought on the most appropriate management of the patient, and a Management Plan is formulated (standard plans below) with the appropriate Healthcare Professional(s) knowledge.

All plans must have Deputy Medical Director sign off before implementation. In the event of the Deputy Medical Directors absence the Medical Director or Director of Nursing and Clinical Quality may sign off on these plans.

All new frequent callers identified must have contact made with SPOC and a Safeguarding referral made, appropriate to the individual’s needs. Either a GP Assistance or Social Care referral to be made in accordance with Safeguarding Vulnerable Adults Policy. All new frequent callers must have a Frequent Caller Risk Assessment completed.

These plans will remain in place indefinitely or until the patient is no longer considered a frequent caller of the service or their situation changes. This will


Frequent Caller Plans

1) Standard Management Plan

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be monitored by the 6 month review.

Each time a call is received the Clinical Coordinator or ECAT Team Leader will be notified. The call will be reviewed by the Clinical Coordinator or ECAT Team Leader to ensure we are clinically safe. The demand on the service and the agreed plan will be reviewed every 6 months.

If the call is made by a HCP then the Clinical Coordinator or ECAT Team Leader will have a discussion with the HCP at the time of the call to discuss the patient and any previous call history.

1. All emergency calls relating to this address, phone number or when identified as the frequent caller will be triaged in ambulance control as per EOC call handling process. 2. Any call prioritised as a life threatening emergency (Category 1) will be responded to in line with resource allocation. 3. Following confirmation that there is no immediate threat to life the call will be passed to an ECAT Clinician within the control room to triage further. (Category 2-4) and the response stood down. 4. The Clinician will contact the patient within the call category timeframe and triage the patient further with a full range of responses and dispositions available – Surge dependent. 5. The patient may be encouraged to access alternative pathways, or use home treatments and no ambulance response will be dispatched. 6. If attendance is deemed appropriate the patient will receive a maximum of one face to face assessment per 24 hour period. 7. If the Clinician is satisfied that no response is required they will inform the patient that they will not receive any further telephone triage for 24 hours.

8. Steps 3-7 of this plan will only occur once every 24 hour period, with all other non- immediate calls being stood down following steps 1 & 2. 9. Any abandoned call from the patient will be deemed a refusal of care – this must be reviewed by the Clinical Coordinator or ECAT Team Leader before the call is closed.


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2) Standard Management Plan – Triage Every Time 1. All emergency calls relating to this address, phone number or when identified as the frequent caller will be triaged in ambulance control as per EOC call handling process. 2. Any call prioritised as a life threatening emergency (Category 1) will be responded to in line with resource allocation. 3. Following confirmation that there is no immediate threat to life the call will be passed to an ECAT Clinician within the control room to triage further. (Category 2-4) and the response stood down. 4. The Clinician will contact the patient within the call category timeframe and triage the patient further with a full range of responses and dispositions available – Surge dependent. 5. The patient may be encouraged to access alternative pathways, or use home treatments and no ambulance response will be dispatched. 6. If attendance is deemed appropriate then an ambulance will be sent. 7. If the Clinician is satisfied that no response is required they will inform the patient that they will not receive an ambulance. 8. This process will happen every time the patient calls. 9. Any abandoned call from the patient will be deemed a refusal of care – this must be reviewed by the Clinical Coordinator or ECAT Team Leader before the call is closed.

2) Standard Management Plan – Triage Every Time 1. All emergency calls relating to this address, phone number or when identified as the frequent caller will be triaged in ambulance control as per EOC call handling process. 2. Any call prioritised as a life threatening emergency (Category 1) will be responded to in line with resource allocation. 3. Following confirmation that there is no immediate threat to life the call will be passed to an ECAT Clinician within the control room to triage further. (Category 2-4) and the response stood down. 4. The Clinician will contact the patient within the call category timeframe and triage the patient further with a full range of responses and dispositions available – Surge dependent.


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5. The patient may be encouraged to access alternative pathways, or use home treatments and no ambulance response will be dispatched. 6. If attendance is deemed appropriate then an ambulance will be sent. 7. If the Clinician is satisfied that no response is required they will inform the patient that they will not receive an ambulance. 8. This process will happen every time the patient calls. 9. Any abandoned call from the patient will be deemed a refusal of care – this must be reviewed by the Clinical Coordinator or ECAT Team Leader before the call is closed.

3) Standard Management Plan – Time Specific 1. All emergency calls relating to this address, phone number or when identified as the frequent caller will be triaged in ambulance control as per EOC call handling process. 2. Any call prioritised as a life threatening emergency (Category 1) will be responded to in line with resource allocation. 3. Following confirmation that there is no immediate threat to life the call will be passed to an ECAT Clinician within the control room to triage further. (Category 2-4) and the response stood down. 4. The Clinician will contact the patient within the call category timeframe and triage the patient further with a full range of responses and dispositions available – Surge dependent. 5. The patient may be encouraged to access alternative pathways, or use home treatments and no ambulance response will be dispatched. 6. If attendance is deemed appropriate the patient will receive a maximum of one face to face assessment per 4/8/12/24 hour period (delete as appropriate). 7. If the Clinician is satisfied that no response is required they will inform the patient that they will not receive any further telephone triage for 4/8/12/24 hours (delete as appropriate). 8. Steps 3- 7 of this plan will only occur once every 4/8/12/24 hour period (delete as appropriate), with all other non-immediate calls being stood down following steps 1 & 2.


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9. Any abandoned call from the patient will be deemed a refusal of care – this must be reviewed by the Clinical Coordinator or ECAT Team Leader before the call is closed

Extra steps can be added into the plans to manage individuals more appropriately, including as an example (but not an exhausted list):

- The Trust will not take calls while the frequent caller is being abusive or using inappropriate language towards our staff on the phone and will terminate these calls after one warning.

- If when the frequent caller calls, if they do not answer return phone calls after 3 attempts, then the event will be close and no further contact will be made until the frequent caller rings again.

- If the frequent caller refuses to attend hospital during the telephone triage, then no ambulance will be sent.

- If the frequent callers address is attended and they are abusive, aggressive or threatening, the crew will take appropriate action and register the incident on Datix for follow up investigation. This will be classed as one ambulance attendance in 24 hours.

- If the frequent caller requests a call back from the psychiatry clinic as their chief complaint then the call handler or duty clinical coordinator is to ring the psychiatry clinic (01727 ******) between 9am and 5pm or the out of hours helpline number (01438 ******) and request a call back for the frequent caller. If following this call back the frequent caller requires an ambulance then the psychiatry clinic are to call back and book it as a HCP referral on 01234 716120.

- We can refer the frequent caller to the duty worker at the psychiatry clinic (01727 ******) between 9am and 5pm or the out of hours helpline number (01438 ******)

The 24 hour period starts from when the patient has been last triaged either by a clinician in EOC or on scene, not from the call time.

EEAST will write to the patient advising them that they have been using the service frequently or regularly, including information on when and how to use our emergency service and other options available locally (Choose Well Leaflet). They will also be notified that the East of England Ambulance Service will be holding a record of their interaction with the ambulance service and that we


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will be reviewing their management plan with their GP and / or other agencies (using the standard letter templates).

9.3 Stage Three (Frequent Caller - 6 Month Review) The management plan will be reviewed every 6 months, and the plans will remain in place until it is deemed reasonable for it to be removed.

If there is no improvement at this review then the Clinical Coordinator Team/Frequent Caller Lead may call a multidisciplinary team meeting (MDT) to discuss an action management plan for the individual patient. This process could happen before the 6 month review period is due if there is an adverse impact on the trust. This can be identified by the monthly reports on Portal Reports, contact with other agencies or providers, from both internal and external incident groups (Datix), from other work streams or through the Trusts Patient Advice & Liaison Service (PALS). The patient will be notified in writing informing them of this action if anything has changed (standard template letter). The Trust may meet with the patient as part of the MDT or as a separate meeting to discuss their call volume.

The Datix record will be updated with any changes and the CAD flag on the patient’s address updated if necessary. Calls will be managed in line with the agreed plan.

9.4 Stage Three (Frequent Caller – 1 Year Review) If no reduction in the frequency of calls is achieved, the case should be reviewed by the Clinical Coordinator, Frequent Caller Lead, EOC Clinical Lead and Deputy Medical Director and a recommendation made to the Trust to either:

- Have a further urgent case review and multidisciplinary team meeting - Write to the patient advising them that we will be taking further action –

court action / injunction, police involvement, etc. - Meet with the patient - Consider court action / injunction

9.5 Temporary Plans Out of hours it may be appropriate to instigate a Temporary Management Plan due to:


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• Excessive 999/111 calls are being received from a caller(s) • Multiple Ambulance attendances and / or ECAT Triages • Relevant HCP may not be contactable • Disruption to our service

Two Clinical Coordinators or a Clinical Coordinator and the EOC Clinical Lead/Frequent Caller Lead can put a Temporary Plan in place, but only after an operational crew or RRV has attended and fully assessed the patient and fed back directly to the Clinical Coordinator. A standard plan will be selected and implemented. It is imperative that when the first in hours Clinical Coordinator is on duty they speak to the appropriate HCP and a permanent plan sorted. All Temporary Plans must have a Frequent Caller Risk Assessment completed.

10.0 Management of Patients with Complex Medical Needs On receipt of patient specific plan/information, the Clinical Coordinator Team/Frequent Caller Lead will coordinate the initial investigation and review the documentation. A CAD marker will be written and actioned in accordance with the CAD Markers Procedure. A Datix will be raised and the patient specific plan / information will be stored on the shared P Drive (accessible to Clinical Coordinators/Frequent Caller Lead/ECAT staff/EOC Managers/limited approved staff).

HCP’s who are responsible for these patients’ plans with be accountable for updating us on any changes or alternations required to these plans.

11.0 Multidisciplinary Working To ensure that appropriate support is available to patients calling the service frequently or regularly, the Trust will:

- Work with local providers of health and social care to identify people using a range of services frequently or regularly and coordinate activity to reduce these calls. This may take the form of case conferences as needed or local forums including representatives from the CCG, mental health providers, out of hour’s services and social services.


- Antisocial Behaviour Orders evolved in 2015 and have become:

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- Refer to the Home Office Guide to antisocial behaviour orders and acceptable behaviour contracts and agreements. The Antisocial Behaviour Order (ASBO) was an addition to the range of measures the Police and local authorities have to tackle antisocial behaviour, introduced as part of the Crime and Disorder Act 1998. ASBOs claim to protect the community from an individual or individuals whose actions are not necessarily criminal but are nevertheless causing harassment, alarm or distress. Proceedings to apply for an ASBO are civil, not criminal, and civil rules of evidence apply, although past acts of antisocial behaviour should be proved to an equivalent of criminal standard. Breaching an ASBO is a criminal offence and the courts can impose penalties of up to five years imprisonment.

- Criminal Behaviour Orders — issued by the courts after conviction, the order will ban an individual from certain activities or places and require them to address their behaviour for example attending drug treatment programmes. A breach would see an individual face a maximum five year prison term

- Crime Prevention Injunctions - designed to nip bad behaviour in the bud before it escalates. The injunction would carry a civil burden of proof, making it quicker and easier to obtain than previous tools. For adults, breach of the injunction could see you imprisoned or fined. For under-18s a breach could be dealt with through curfews, supervision or detention

- Patients falling into the above categories should have a specific review by the Director of Nursing and Clinical Quality or Medical Director before an application is made. This may include the seeking of a legal opinion by the Trust.

A report of all patients who have been written to informing them of the alternative response to their 999 call should be monitored by the CQSG. This should continue until the Trust’s legal duty to respond to all 999 calls received is amended.


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12.0 Information Sharing Wherever possible, consent should be obtained from the patient before passing on personal information to other agencies. Due regard should be given to involving the patient’s relatives, carer or advocate, where the patient consents to this (with due regard to personal safety).

Paragraph 8 of Schedule 2 of the Data Protection Act (1998) allows the sharing of information where that is necessary for medical purposes and is carried out by medical professionals or others owing an obligation of confidence to the data subject. Personal data consisting of information relating to the physical or mental health condition of the patient is also covered in 30(3) (b) DPA (1998) in relation to the purposes of carrying out social work. The Trust takes the view that this area of work falls within these provisions, towards the establishment of an emergency care component of a community care plan.

It is possible to share information directly with other NHS organisations who are also bound by Caldecott principles.

The Trust will also formalise an information sharing agreement with the CCGs for the purposes of this policy (already in place with LSAB and LSCB Board).

13.0 Process for Monitoring Compliance and Effectiveness IMT teams will be responsible for carrying out audits and monitoring the effectiveness and safety of the Trust’s Management of Patients with Defined Individual Needs Policy and will report to the Clinical Quality Safety Review Group on a quarterly basis. This review will include how many patients who meet the definition of being a frequent or regular user are being managed through the EOC and Operations, any care plans in place, reassurance that the care plans are reviewed appropriately, the impact of any care plans (reduction in number of contacts) and any issues arising from the process.

Key monitoring indicators and responsibilities are listed in Appendix E.

14.0 Standards / Key Performance Indicators The specific Ambulance Quality Indicator (AQI) related to this area is


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SQU03_2_3_1 (Emergency calls from patients for whom a locally agreed frequent caller procedure is in place) as follows:

“Emergency calls from patients for whom a frequent caller procedure is in place should be reported, and the narrative explanation of performance for this component of the indicator should refer to what actions the trust is taking to manage and provide an appropriate clinical service to these frequent callers.

Frequent caller procedures should be locally determined; these procedures should relate to individual patients and be agreed with that individual and the main care provider (e.g. GP, Mental Health Service).”

15. Associated Documents Computer Aid Dispatch (CAD) Markers Policy Investigations Policy Patient Confidentiality Policy Safeguarding Policies


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--

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Identified Safeguarding concern

1. A Child Social Carereferral is made to the

Local Authority for further assessment and copied to the persons

GP.

2. The GP is alerted tothe child’s use of

Emergency Services, for further assessment.

Table one <18 years by

individual name and address >2 calls in a 6

monthly rolling period

A location or individual:

who is already classed as a frequent

caller where escalation is required.

identified as part of other workstreams. identified as part of incident reporting with internally or

externally. identified as part of

a PALS enquiry. where other agencies

have contacted EEAST

Frequent Caller identified Via Trigger Points (Table One)

Clinical Coordinator Team/Frequent Caller Lead gather information on the

individual that has been identified

Clinical Coordinator Team/Frequent Caller Team review the patient.

Identify, from information received, key themes covering physiological,

psychological, sociological and environmental (including physical and

weather). Safeguarding Team are consulted to formulate a plan.

Patient has a medical condition Clinical Coordinator

Team/Frequent Caller Lead for review and management plan

agreed.

Important Notes: Document each

stage clearly with the themes and

issues the facts and associated evidence.

Ensure that any attendance on multiagency meetings are documented.

Where contact is made outside of the PALS service

ensure this is documented either

through PALS or Adastra.

Where any action or management plan exists this

should be available for relevant

organisations. Any sharing of

information needs to follow Caldicott principles and data sharing protocols.

Consideration should be given to

a vulnerable or safeguarding

referral.

#WeAreEEAST


Appendix A: Frequent Caller Management <18 Years Flow Chart


–

–

–

--

-

-

-

-

Frequent Caller Identified via trigger points (table one)

Liaison between the Clinical Coordinator, Frequent Caller Lead and Management

Green tier frequent caller as per stage one the patient and their GP will be

sent a ‘green tier advisory’ letter by the frequent caller team.

Amber, red, black tier & green tier frequent callers three months since

initial letter as per stage two these patients will be reviewed for a

management plan.

Information gathered on the individual that has triggered assess clinical records,

DATIX, CAD and any existing flag or management plan in place.

Safeguarding referral to be made via SPOC for newly identified frequent

callers identified. All new frequent callers must have a

Frequent Caller Risk Assessment completed.

Frequent caller is given a tier level based on call volume.

Table one >18 years, by

individual address >5 calls (Individual episodes of care) in a 1 month period.

>18 years, by individual address

>12 calls (Individual episodes of care) in a 3 month period

>18 years, by communal address

>15 calls in a 1 month period.

A location or individual:

who is already classed as a

frequent caller where escalation is

required. identified as part

of other workstreams.

identified as part of incident

reporting with internally or externally.

identified as part of a PALS enquiry.

where other agencies have

contacted EEAST.

Important Notes: Document each

stage clearly with the themes and issues the facts and associated

evidence.

Ensure that any attendance on multiagency meetings are documented.

Where contact is made outside of the PALS service

ensure this is documented

either through PALS or DATIX.

Where any action or management plan exists this

should be available for

relevant organisations.

Any sharing of information needs to follow Caldicott

principles and data sharing

protocols.

Consideration should be given to

a vulnerable or safeguarding

referral.

#WeAreEEAST


Appendix B: Frequent Caller Management >18 Years Flow Chart


27

Management Plan put in place

Action Plans and agreements under review as defined or at least every 12 months

Safeguarding Team review of <18’s for correct pathway

Safeguarding Team review all > 18 new frequent callers, referred by clinical Coordinator/Frequent

Caller Lead to SPOC

>18 yrs Patients managed by the Clinical Coordinator/Frequent caller Lead who review

Patient Care Records

Clinical Coordinator/Frequent caller lead liaise with Local Operations Team

Care Plans established locally and recorded onto the Datix record. Clinical Coordinator/Frequent Caller Lead ensure appropriate CAD Flag with

CAD team

All patients managed within Safeguarding will be accounted for within the Datix

database.

Specific information may be withheld as appropriate.

Monthly report provided by the Clinical Coordinator/Frequent Caller Lead on number of active individual management plans recorded

within the Datix database

Information Team Complete Trust AQI report

#WeAreEEAST


Appendix C: Frequent Caller Information Process

POL038 Management of Patients with Defined individual Needs

l

Are they a 1 in 4/8/12/24 hour triage?

Eligible for ECAT Fridge as per plan

Category 2-4

Allocate as per Resource

Allocation

Category 1

Code call as per MPDS and read SPEC. Sit (Red Box)

Frequent Caller with a management plan phones 999 for an ambulance or someone else calls on their

behalf

Frequent Caller 999 Call Management

Refer to Clinical Coordinator

Urgent

YES NO

Is this call within 4/8/12/24 hours of a duplicate call that has been triaged or attended by a crew??

Check info only appointment time is within 24 hours

Call Handler to give no further action speech

Call handler to give LOWCODE

speech

ECAT to manage call in LOWCODE

NO

#WeAreEEAST


Appendix D : EOC Frequent Caller Process


#WeAreEEAST


Pre arrival Speech: As per ProQA

LowCode Speech: “From the information you have given me your call is appropriate for further clinical assessment and I am going to arrange for one of our clinicians to call you back. Our aim is to do this within ** minutes , if this isn’t possible we will contact you. Is it okay to call you back on this number? May I take your / the patient’s name, DOB and GP name please.”

(1st Party Callers) “Do you consent to our clinician viewing your health records to aid assessment?” (2nd, 3rd Party callers) “Please ask the patient if they consent to our clinician viewing their health records to aid assessment?”

“It is important that we are able to contact you, please keep the line clear so we can contact you and if s/he gets worse in any way, call us back immediately for further instructions”.

No further action speech: ‘’From the information you have given me and as per your Ambulance Response Plan, you will not be receiving a call back from a clinician or an ambulance at this time”.



Appendix E: Patient with Complex Medical Needs Management Flow Chart

HCP/Specialist GP Letter received

Notification by staff or other agency

Patient letter

Pass to clinical Coordinator

Team/Frequent Caller EEAST approval (Multiagency

meeting if required) Letter to patient Investigate

Populate on CAD Flag and Save file to P drive folder EOC CAD

Markers

Class review if required

Contact HCP, patient staff,

other agency etc if required

Copy of form to primary care (auto

email from database)

Add information to Datix database

___ /

HCP to update if the plan changes

Inform local Operational Team

HCP to update if the plan changes

#WeAreEEAST


#WeAreEEAST


Sign off:

For information only Clinical Coordinator/Frequent Caller Lead

Patient specific drug Doctor

For variation from normal practice Area Clinical Lead/SEM/SLM (Medical Director where required)


Our reference : DATIX REFERENCE Date : -2017

Dr XXXXX GP ADDRESS

Dear Dr XXXXX

-

--I

#WeAreEEAST


Appendix F: Standard Letter to GP

Bedford Office Hammond Road

Bedford MK41 0RG

Tel: 0345 6013733

Re: Ambulance Attendance to Patient name and address

I am writing regarding the above named patient who is registered with your surgery. Following a review of 999 activity, this patient is considered a frequent user of the ambulance service and despite crew and clinical advice s/he is still putting an inappropriate demand on the Ambulance 999 service. S/he has called us ** times since **/**/2017. You may be more familiar with this patient than ourselves and we would appreciate your review of the response plan (below) which we are planning on implementing.

Even though the patient is triaged by our specialist clinicians once every 4/8/12/24 hours for the usual presentation, the clinical team will keep an oversight of further calls ensuring any different presentation or change in patient activity will be assessed on its own merit.

We will be taking the clinical risk as a Trust for this management plan and all plans are only implemented once discussion of the plan and patient has taken place with Dr Tom Davis (Medical Director (Interim) and Named Doctor for safeguarding; East of England Ambulance Service NHS Trust, EEAST).

To support us with the direct clinical care of the patient we would also be grateful if you could:


-

--

#WeAreEEAST


- Send us any other relevant information about her/him that could help us to manage her/his usage of our service more effectively.

-If there are any immediate concerns that need sharing please contact Helen Burtrand (Frequent Caller Lead, EEAST) on 07925894337.

- Alert the Trust to any relevant agency involvement in his/her care. - Add this plan to her/his special notes on SystmOne/their patient care

system record, so it can be seen by other agencies. - Keep us updated with any changes to the patient’s condition and/or care

that you become aware of. - No response to the above will be considered that there is no relevant

information to share and assume that this plan will be live within four weeks of the date of this letter.

If appropriate, we would be happy to arrange a meeting with a multi-disciplinary team to agree a care plan tailored to the needs of this patient. We are required to notify the patient of the existence of this plan, which we will do by letter.

Call Categories:

Category 1 - Life-threatening injuries and illnesses Patients will be responded to in an average (mean) time of 7 minutes and within 15 minutes at least nine out of 10 times (90th percentile)

Category 2 - Emergency calls These will be responded to in an average (mean) time of 18 minutes and within 40 minutes at least nine out of 10 times (90th percentile).

Category 3 - Urgent calls In some instances where patients may be treated in their own home/not conveyed [for those people who aren’t in their own home like in a public place] or referred to a different pathway of care. These types of calls will be responded to at least nine out of 10 times (90th percentile) within 120 minutes.


#WeAreEEAST


Category 4 - Less urgent calls In some instances patients may be given advice over the phone or referred to another service such as a GP or pharmacist. These less urgent calls will be responded to at least nine out of 10 times (90th percentile) within 180 minutes.

Patients Name Response Plan; Insert relevant response plan

3) Standard Management Plan 10. All emergency calls relating to this address, phone number or when identified as Patients Name will be triaged in ambulance control as per EOC call handling process. 11. Any call prioritised as a life threatening emergency (Category 1) will be responded to in line with resource allocation. 12. Following confirmation that there is no immediate threat to life the call will be passed to an ECAT Clinician within the control room to triage further. (Category 2-4) and the response stood down. 13. The Clinician will contact the patient within the call category timeframe and triage the patient further with a full range of responses and dispositions available – Surge dependent.

14. The patient may be encouraged to access alternative pathways, or use home treatments and no ambulance response will be dispatched.

15. If attendance is deemed appropriate the patient will receive a maximum of one face to face assessment per 24 hour period.

16. If the Clinician is satisfied that no response is required they will inform the patient that they will not receive any further telephone triage for 24 hours.

17. Steps 3-7 of this plan will only occur once every 24 hour period, with all other non-immediate calls being stood down following steps 1 & 2.

18. Any abandoned call from the patient will be deemed a refusal of care – this must be reviewed by the Clinical Coordinator or ECAT Team Leader before the call is closed.


#WeAreEEAST


4) Standard Management Plan – Triage Every Time 10. All emergency calls relating to this address, phone number or when identified as Patients Name will be triaged in ambulance control as per EOC call handling process. 11. Any call prioritised as a life threatening emergency (Category 1) will be responded to in line with resource allocation. 12. Following confirmation that there is no immediate threat to life the call will be passed to an ECAT Clinician within the control room to triage further. (Category 2-4) and the response stood down. 13. The Clinician will contact the patient within the call category timeframe and triage the patient further with a full range of responses and dispositions available – Surge dependent. 14. The patient may be encouraged to access alternative pathways, or use home treatments and no ambulance response will be dispatched. 15. If attendance is deemed appropriate then an ambulance will be sent. 16. If the Clinician is satisfied that no response is required they will inform the patient that they will not receive an ambulance. 17. This process will happen every time the patient calls. 18. Any abandoned call from the patient will be deemed a refusal of care – this must be reviewed by the Clinical Coordinator or ECAT Team Leader before the call is closed.

4) Standard Management Plan – Time Specific 10. All emergency calls relating to this address, phone number or when identified as Patients Name will be triaged in ambulance control as per EOC call handling process. 11. Any call prioritised as a life threatening emergency (Category 1) will be responded to in line with resource allocation. 12. Following confirmation that there is no immediate threat to life the call will be passed to an ECAT Clinician within the control room to triage further. (Category 2-4) and the response stood down. 13. The Clinician will contact the patient within the call category timeframe


#WeAreEEAST


and triage the patient further with a full range of responses and dispositions available – Surge dependent. 14. The patient may be encouraged to access alternative pathways, or use home treatments and no ambulance response will be dispatched. 15. If attendance is deemed appropriate the patient will receive a maximum of one face to face assessment per 4/8/12/24 hour period (delete as appropriate). 16. If the Clinician is satisfied that no response is required they will inform the patient that they will not receive any further telephone triage for 4/8/12/24 hours (delete as appropriate). 17. Steps 3- 7 of this plan will only occur once every 4/8/12/24 hour period (delete as appropriate), with all other non-immediate calls being stood down following steps 1 & 2. 18. Any abandoned call from the patient will be deemed a refusal of care – this must be reviewed by the Clinical Coordinator or ECAT Team Leader before the call is closed


The Trust will not take calls while Patients Name is being abusive or using inappropriate language towards our staff on the phone and will terminate these calls after one warning.

If when Patients Name calls, if they do not answer return phone calls after 3 attempts, then the event will be close and no further contact will be made until the frequent caller rings again.

If Patients Name refuses to attend hospital during the telephone triage, then no ambulance will be sent.

If Patients Name address is attended and they are abusive, aggressive or threatening, the crew will take appropriate action and register the incident on Datix for follow up investigation. This will be classed as one ambulance attendance in 24 hours.

If Patients Name requests a call back from the psychiatry clinic as their chief complaint then the call handler or duty clinical coordinator is to ring the psychiatry clinic (01727 ******) between 9am and 5pm or the out of hours helpline number (01438 ******) and request a call back for the



NHS Trust


frequent caller. If following this call back the frequent caller requires an ambulance then the psychiatry clinic are to call back and book it as a HCP referral on 01234 716120.

We can refer Patients Name to the duty worker at the psychiatry clinic(01727 ******) between 9am and 5pm or the out of hours helplinenumber (01438 ******)

The 4/8/12/24 hour period starts from when the patient has been last triaged either by a clinician in EOC or on scene, not from the call time.

EEAST will write to the patient advising them that they have been using the service frequently or regularly, including information on when and how to use our emergency service and other options available locally (Choose Well Leaflet). They will also be notified that the East of England Ambulance Service will be holding a record of their interaction with the ambulance service and that we will be reviewing their management plan with their GP and / or other agencies.

Declaration I am in agreement with the response plan detailed above for Patients Name.

Signed: Dr Tom Davis Dated……………………

Name: Dr Tom Davis Medical Director (Interim) and Named Doctor for Safeguarding, EEAST

I look forward to hearing back from you. Yours Sincerely,

Helen Burtrand Helen Burtrand Frequent Caller Lead 07925894337 [email protected]


mailto:[email protected]

#WeAreEEAST


Standard Review Letter to GP

Our re

-ference: DATIX REFERENCE Bedford Office

Hammond Road Date: 2017 Bedford

MK41 0RG

Dr XXXXX GP ADDRESS Tel: 0345 6013733

Dear Dr XXXXX


I am writing regarding the above named patient who is registered with your surgery. Their ambulance response plan, which you kindly noted previously, is due for a review.

Option 1) This patient is still considered a frequent user of the ambulance


service, and d espite crew and clinical advice s/he is still p utting an inappropriate demand on the Ambulance 999 service. S/he has called us ** times since **/**/2017. We would be grateful if we could hold a multi-disciplinary team meeting to discuss the needs of th is p atient which I am more than happy t o arrange. Are you a ble to provide the details of any care providers to the patient if you have these? Option 2) This patient is still considered a frequent user of the ambulance service; however their call volume has decreased. S/he has called us ** times since **/**/2017. Option 3) This patient is no longer considered a frequent user of th e ambulance service, however w e would like to k eep their plan a ctive for a further 6 months in case the situation changes. S/he has called us ** times since **/**/2017. Option 4) This patient is no longer considered a frequent user of th e ambulance service and we are removing their ambulance management pl an.

This patient will be remaining on the same response plan as d etailed i n o ur previous correspondence. OR

#WeAreEEAST


We have changed the response plan this patient is on and the details of the new plan are below.

The below information will be deleted as appropriate:

Patients Name Response Plan; Insert relevant response plan

5) Standard Management Plan 19. All emergency calls relating to this address, phone number or when identified as Patients Name will be triaged in ambulance control as per EOC call handling process. 20. Any call prioritised as a life threatening emergency (Category 1) will be responded to in line with resource allocation 21. Following confirmation that there is no immediate threat to life the call will be passed to an ECAT Clinician within the control room to triage further. (Category 2-4) and the response stood down. 22. The Clinician will contact the patient within the call category timeframe and triage the patient further with a full range of responses and dispositions available – Surge dependent. 23. The patient may be encouraged to access alternative pathways, or use home treatments and no ambulance response will be dispatched. 24. If attendance is deemed appropriate the patient will receive a maximum of one face to face assessment per 24 hour period. 25. If the Clinician is satisfied that no response is required they will inform the patient that they will not receive any further telephone triage for 24 hours. 26. Steps 3-7 of this plan will only occur once every 24 hour period, with all other non-immediate calls being stood down following steps 1 & 2. 27. Any abandoned call from the patient will be deemed a refusal of care – this must be reviewed by the Clinical Coordinator or ECAT Team Leader before the call is closed.


#WeAreEEAST


6) Standard Management Plan – Triage Every Time 19. All emergency calls relating to this address, phone number or when identified as Patients Name will be triaged in ambulance control as per EOC call handling process. 20. Any call prioritised as a life threatening emergency (Category 1) will be responded to in line with resource allocation. 21. Following confirmation that there is no immediate threat to life the call will be passed to an ECAT Clinician within the control room to triage further. (Category 2-4) and the response stood down. 22. The Clinician will contact the patient within the call category timeframe and triage the patient further with a full range of responses and dispositions available – Surge dependent. 23. The patient may be encouraged to access alternative pathways, or use home treatments and no ambulance response will be dispatched. 24. If attendance is deemed appropriate then an ambulance will be sent. 25. If the Clinician is satisfied that no response is required they will inform the patient that they will not receive an ambulance. 26. This process will happen every time the patient calls. 27. Any abandoned call from the patient will be deemed a refusal of care – this must be reviewed by the Clinical Coordinator or ECAT Team Leader before the call is closed.

5) Standard Management Plan – Time Specific 19. All emergency calls relating to this address, phone number or when identified as Patients Name will be triaged in ambulance control as per EOC call handling process. 20. Any call prioritised as a life threatening emergency (Category 1) will be responded to in line with resource allocation. 21. Following confirmation that there is no immediate threat to life the call will be passed to an ECAT Clinician within the control room to triage further. (Category 2-4) and the response stood down. 22. The Clinician will contact the patient within the call category timeframe and triage the patient further with a full range of responses and dispositions available – Surge dependent.


--

#WeAreEEAST


23. The patient may be encouraged to access alternative pathways, or use home treatments and no ambulance response will be dispatched. 24. If attendance is deemed appropriate the patient will receive a maximum of one face to face assessment per 4/8/12/24 hour period (delete as appropriate). 25. If the Clinician is satisfied that no response is required they will inform the patient that they will not receive any further telephone triage for 4/8/12/24 hours (delete as appropriate). 26. Steps 3- 7 of this plan will only occur once every 4/8/12/24 hour period (delete as appropriate), with all other non-immediate calls being stood down following steps 1 & 2. 27. Any abandoned call from the patient will be deemed a refusal of care – this must be reviewed by the Clinical Coordinator or ECAT Team Leader before the call is closed


The Trust will not take calls while Patients Name is being abusive or using inappropriate language towards our staff on the phone and will terminate these calls after one warning.

If when Patients Name calls, if they do not answer return phone calls after 3 attempts, then the event will be close and no further contact will be made until the frequent caller rings again.

If Patients Name refuses to attend hospital during the telephone triage, then no ambulance will be sent.

If Patients Name address is attended and they are abusive, aggressive or threatening, the crew will take appropriate action and register the incident on Datix for follow up investigation. This will be classed as one ambulance attendance in 24 hours.

If Patients Name requests a call back from the psychiatry clinic as their chief complaint then the call handler or duty clinical coordinator is to ring the psychiatry clinic (01727 ******) between 9am and 5pm or the out of hours helpline number (01438 ******) and request a call back for the frequent caller. If following this call back the frequent caller requires an


#WeAreEEAST


ambulance then the psychiatry clinic are to call back and book it as a HCP referral on 01234 716120.

We can refer Patients Name to the duty worker at the psychiatry clinic (01727 ******) between 9am and 5pm or the out of hours helpline number (01438 ******)

The 24 hour period starts from when the patient has been last triaged either by a clinician in EOC or on scene, not from the call time.

EEAST will write to the patient advising them that they have been using the service frequently or regularly, including information on when and how to use our emergency service and other options available locally (Choose Well Leaflet). They will also be notified that the East of England Ambulance Service will be holding a record of their interaction with the ambulance service and that we will be reviewing their management plan with their GP and / or other agencies.

Declaration

I am in agreement with the response plan detailed above for Patients Name.

Signed: Dr Tom Davis Dated……………………


I look forward to hearing back from you.

Yours Sincerely,




Our reference : DATIX Bedford Office REFERENCE / Date :2017 Hammond Road

Bedford MK41 0RG

PATIENT NAME Tel: 0345 6013733 PATIENT ADDRESS

Dear Patients name,

--

-

r.•1:bj East of England

Ambulance Service NHS Trust

#WeAreEEAST

•


Standard Letter to Patient

Re; Repeat 999 calls and Ambulance Attendance.

I am writing to you following a review of emergency calls received from you recently. You have called us in excess of ***** times since **/**/**** and *** times in the last month from your house / mobile phone. Dialling 999 should be for life threatening emergencies only, which we hope are not frequent occurrences for patients in the East of England.

Your level of activity is considered well above a normal range and I wish to make you aware of alternative services that may be more appropriate than an emergency response. I have enclosed a ‘Choose Well’ leaflet which I hope you will find useful in choosing the appropriate service for your need.

We are aware that you have some medical problems and we are committed to assisting you, however in the future we may adjust our response to your calls which could mean an ambulance will not be sent to you on every occasion. We have clinicians (Paramedics and Nurses) in our control room and they may be in a position to aid you over the phone and refer you to alternative care pathways.


#WeAreEEAST


I would also like to highlight that if you feel you require hospital intervention you can attend an Accident and Emergency Department by yourself without the need of the ambulance service e.g. by using a taxi.

Insert relevant response plan explanation

I have liaised with your General Practitioner regarding your health care needs and as you have called us many times we have put a plan in place to assist you. Unless your condition is deemed life threatening, you will be offered one triage from one of our clinicians (paramedics/nurses) in the control room every 4/8/12/24 hours. When you call us if your condition is of a high priority then you will be called back within 20 minutes to discuss your needs. If your call is deemed a low priority then we will call you back within 60 minutes. Any subsequent calls will be coded appropriately and if not deemed life threatening you will not be spoken to again and this will be explained to you at the time. If an ambulance is dispatched to you, this ambulance attendance will also be classed as one 4/8/12/24 hour a day triage. You will not be conveyed to hospital by us if you do not need to attend A&E after our triage over the phone or when on scene. If you feel you want to go then you will need to make you own way there.

I have liaised with your General Practitioner regarding your health care needs and as you have called us many times we have put a plan in place to assist you. Unless your condition is deemed life threatening when you call us, you will be offered clinical telephone triage from one of our clinicians (paramedics/nurses) in the control room. If your condition is of a high priority then you will be called back within 20 minutes to discuss your needs. If your call is deemed a low priority then we will call you back within 60 minutes. This will now happen every time you call us. You will not be conveyed to hospital by us if you do not need to attend A&E after our triage over the phone or when on scene. If you feel you want to go then you will need to make you own way there.

It is important that you answer your phone and take our call backs, as we cannot help you if you are not answering the phone.

The East of England Ambulance Service NHS Trust fully supports the NHS Tackling Violence and Aggression against Staff Campaign with the objective of


#WeAreEEAST


reducing incidents where staff suffer from acts of violence and/or aggression. Violence and aggression towards employees is a crime and will not be tolerated. The Trust will press the Police and Crown Prosecution Service (CPS) for the maximum possible penalty for anyone who behaves in a violent, aggressive or abusive way to Trust staff. The Trust operates a policy giving the option of withholding treatment from violent and abusive patients if they continue to act in an inappropriate manner.” Therefore, from now on we will no longer take your calls while you are being abusive or using inappropriate language towards our staff on the phone, we will terminate these calls after one warning. The same will apply if an ambulance attends you, the crew will leave scene and will not return to you.

If you call volume to our service is not reduced then we will have no alternative but to take further action. If you are concerned about your health, please contact your surgery and arrange a consultation.

If you would like to discuss this further please write to myself at the above address.

Yours Sincerely,

Frequent Caller Lead On Behalf of the East of England Ambulance Service NHS Trust


-

-

,~1:kj East of England


#WeAreEEAST

•


Standard Review Letter to Patient

Our reference :DATIX REFERENCE / Bedford Office Date :2017 Hammond Road

Bedford MK41 0RG

Tel: 0345 6013733 PATIENT NAME PATIENT ADDRESS

Dear Patients name,


I am writing to you following a review of emergency calls received from you recently. You have called us in excess of ***** times since **/**/**** and *** times in the last month from your house / mobile phone. Dialling 999 should be for life threatening emergencies only, which we hope are not frequent occurrences for patients in the East of England.

You are still considered a frequent user of the ambulance service, and despite crew and clinical advice you are still putting an excesses demand on the Ambulance 999 service. Therefore I have arranged a meeting with a multi-disciplinary team to discuss your needs; this will include your GP and any other care providers.

This will take place on **/**/**** at **:**, at *******************************. I would be grateful if you could confirm if you are able to attend. If this date, time or location is not convenient I am happy to rearrange or if you would prefer we can visit you at a date, time and location convenient to you.

We are aware that you have some medical problems and we are committed to assisting you.


#WeAreEEAST


If you call volume to our service is not reduced then we will have no alternative but to take further action. If you are concerned about your health, please contact your surgery and arrange a consultation.

If you would like to discuss this further please write to myself at the above address.

Yours Sincerely,



-

,,•t:bj East of England


#WeAreEEAST


Under 18’s Standard Letter to GP

Our reference :DATIX REFERENCE / Date :2017

GP Practice Manager: GP Address:

Dear Dr,

Bedford Office

Hammond Road

Bedford

MK41 0RG

Tel: 0345 6013733

Management of Young Persons with Defined Individual Needs

Re: Patient Name, Address and DOB

The East of England Ambulance Service NHS Trust, under Safeguarding principles set out in the Children’s Act 2004, monitor service provision to children and young people. In the interest of information sharing, seamless working and protection of children, we write this letter regarding the above person, identified on the NHS Spine as registered at your practice.

The above young person has recently been identified as a frequent user of the East of England Ambulance Service Trust, as identified with a frequency of 3 or more calls over a 6 month rolling period. The Trust is required to manage the use of services and to ensure that all Frequent users are identified and have their defined needs supported.

The frequency of the Trusts attendances has been only obtained from Electronic Patient Care records which have been completed by Ambulance crews. Consequently, further Ambulance attendances for this person are possible, where paper Patient Care records have been recorded are not included in our


#WeAreEEAST


evaluation or the patient may have been accessed on other locations other than the home address.

Electronic Patient Care Records have recorded our attendances on the following dates for the following Chief complaints;

Date Chief Complaint

Date Chief Complaint

Dater Chief Complaint

Our initial review, from information from Trust attendances, where assessments have been undertaken in an urgent or emergency situation, without prior information or full knowledge of the person’s circumstances, suggest that you may already be aware of this young person’s medical condition.

We know that in some circumstances patients do need to call us frequently but could the patient and/or their records be reviewed to ensure that this pattern of calling does not reflect an unmet clinical need.

The East of England Ambulance Service NHS Trust does not require any feedback regarding this child or young person or confirmation of any medical condition.

Yours sincerely

Dr Tom Davis Dated……………………



-,~1:;1


NHS Trust

■

#WeAreEEAST


Green Letter to GP


Frequent Caller Team Chelmsford Office Dr XXXXX

Broomfield GP ADDRESS Chelmsford

Essex CM1 7SW

Dear Dr XXXXX Tel: 0800 0283382


I am writing regarding the above-named patient who is registered with your surgery. Following a review of 999 activity, this patient has been highlighted as a frequent caller and has called the ambulance service ** times since **/**/2017.

We have written separately to the patient to advise them to contact the surgery directly with a view to arranging an appointment with a GP. We feel an opportunity to discuss their current health and medical needs and to advise of any changes or new problems they are experiencing may be beneficial.

We will keep track of the patient’s 999 calls and the outcomes of those calls in future, and if we are concerned that their call volume is escalating, we may need to contact you further to make you aware of this.

If you have any questions for us or any concerns regarding your patient, please do contact me via the contact information below.

Yours Sincerely,




r~t:bj • . East of England


#WeAreEEAST


Green Letter to Patient


Frequent Caller Team Chelmsford Office

Broomfield PATIENT NAME Chelmsford PATIENT ADDRESS Essex

CM17SW

Dear Patients name,


At the East of England Ambulance Service, we are always looking for ways to improve our patients’ experience of our service, and to ensure they receive the most appropriate care.

The reason I am writing to you is that we can see that you have had to call 999 on a few occasions recently and feel you might benefit from some further support. It may be that your current health needs are not best met by calling an emergency ambulance crew, and we think it would be helpful for you to book an appointment with your GP. This would provide an opportunity for you to discuss your current health and medical conditions, and to tell your GP about any changes or new problems you may be experiencing. You should take a copy of this letter with you, but we will also contact your GP surgery to tell them that you have had recent contact with the East of England Ambulance Service.

We will keep track of your 999 calls and the outcomes of those calls in future, and if we are concerned that your needs are still not being met, we may need to talk to other professionals, such as your GP and other community teams, to see how they can help you. We do this with your best interests at heart, as we want to ensure that you receive the care that is right for you in the future. However, if you do experience an emergency health problem and feel you need an ambulance, it is important that you call 999. If you have a health problem that you know is not an emergency but are unsure what to do about it, please contact your GP or dial 111 for the NHS 111 service, as they will be able to provide you with helpful advice and information.


#WeAreEEAST


Thank you very much for taking the time to read this letter if you have any questions please do contact us on the number above. For more information about the information we hold about you and how we handle your data, please visit: https://www.eastamb.nhs.uk/about-us/dataprotection.

Yours Sincerely,



https://www.eastamb.nhs.uk/about-us/dataprotection