Modelling NHS England 111 demand for primary care services: a discrete event simulation
Objectives This feasibility study aimed to model in silico the current healthcare system for patients triaged to a primary care disposition following a call to National Health Service (NHS) 111 and determine the effect of reconfiguring the healthcare system to ensure a timely primary care service co...
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2023-09-01
|
| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/13/9/e076203.full |
| _version_ | 1797667954303696896 |
|---|---|
| author | Jonathan Green Colin A O'Keeffe Richard Pilbery Daniel Chalk Madeleine Smith |
| author_facet | Jonathan Green Colin A O'Keeffe Richard Pilbery Daniel Chalk Madeleine Smith |
| author_sort | Jonathan Green |
| collection | DOAJ |
| description | Objectives This feasibility study aimed to model in silico the current healthcare system for patients triaged to a primary care disposition following a call to National Health Service (NHS) 111 and determine the effect of reconfiguring the healthcare system to ensure a timely primary care service contact.Design Discrete event simulation.Setting Single English NHS 111 call centre in Yorkshire.Participants Callers registered with a Bradford general practitioner who contacted the NHS 111 service in 2021 and were triaged to a primary care disposition.Primary and secondary outcome measures Face validity of conceptual model. Comparison between real and simulated data for quarterly counts (and 95% CIs) for patient contact with emergency ambulance (999), 111, and primary and secondary care services. Mean difference and 95% CIs in healthcare system usage between simulations and difference in mean proportion of avoidable admissions for callers who presented to an emergency department (ED).Results The simulation of the current system estimated that there would be 39 283 (95% CI 39 237 to 39 328) primary care contacts, 2042 (95% CI 2032 to 2051) 999 calls and 1120 (95% CI 1114 to 1127) avoidable ED attendances. Modifying the model to ensure a timely primary care response resulted in a mean percentage increase of 196.1% (95% CI 192.2% to 199.9%) in primary care contacts, and a mean percentage decrease of 78.0% (95% CI 69.8% to 86.2%) in 999 calls and 88.1% (95% CI 81.7% to 94.5%) in ED attendances. Avoidable ED attendances reduced by a mean of −26 (95% CI −35 to −17).Conclusion In this simulated study, ensuring timely contact with a primary care service would lead to a significant reduction in 999 and 111 calls, and ED attendances (although not avoidable ED attendance). However, this is likely to be impractical given the need to almost double current primary care service provision. Further economic and qualitative research is needed to determine whether this intervention would be cost-effective and acceptable to both patients and primary care clinicians. |
| first_indexed | 2024-03-11T20:22:03Z |
| format | Article |
| id | doaj.art-1c1c572dcf114691a80e4ed1d7818596 |
| institution | Directory Open Access Journal |
| issn | 2044-6055 |
| language | English |
| last_indexed | 2024-03-11T20:22:03Z |
| publishDate | 2023-09-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj.art-1c1c572dcf114691a80e4ed1d78185962023-10-03T00:00:07ZengBMJ Publishing GroupBMJ Open2044-60552023-09-0113910.1136/bmjopen-2023-076203Modelling NHS England 111 demand for primary care services: a discrete event simulationJonathan Green0Colin A O'Keeffe1Richard Pilbery2Daniel Chalk3Madeleine Smith43University of Plymouth, UKSchool of Health and Related Research, The University of Sheffield, Sheffield, UK1Yorkshire Ambulance Service NHS Trust, UKMedical School, University of Exeter, Exeter, UK2NHS Devon, UKObjectives This feasibility study aimed to model in silico the current healthcare system for patients triaged to a primary care disposition following a call to National Health Service (NHS) 111 and determine the effect of reconfiguring the healthcare system to ensure a timely primary care service contact.Design Discrete event simulation.Setting Single English NHS 111 call centre in Yorkshire.Participants Callers registered with a Bradford general practitioner who contacted the NHS 111 service in 2021 and were triaged to a primary care disposition.Primary and secondary outcome measures Face validity of conceptual model. Comparison between real and simulated data for quarterly counts (and 95% CIs) for patient contact with emergency ambulance (999), 111, and primary and secondary care services. Mean difference and 95% CIs in healthcare system usage between simulations and difference in mean proportion of avoidable admissions for callers who presented to an emergency department (ED).Results The simulation of the current system estimated that there would be 39 283 (95% CI 39 237 to 39 328) primary care contacts, 2042 (95% CI 2032 to 2051) 999 calls and 1120 (95% CI 1114 to 1127) avoidable ED attendances. Modifying the model to ensure a timely primary care response resulted in a mean percentage increase of 196.1% (95% CI 192.2% to 199.9%) in primary care contacts, and a mean percentage decrease of 78.0% (95% CI 69.8% to 86.2%) in 999 calls and 88.1% (95% CI 81.7% to 94.5%) in ED attendances. Avoidable ED attendances reduced by a mean of −26 (95% CI −35 to −17).Conclusion In this simulated study, ensuring timely contact with a primary care service would lead to a significant reduction in 999 and 111 calls, and ED attendances (although not avoidable ED attendance). However, this is likely to be impractical given the need to almost double current primary care service provision. Further economic and qualitative research is needed to determine whether this intervention would be cost-effective and acceptable to both patients and primary care clinicians.https://bmjopen.bmj.com/content/13/9/e076203.full |
| spellingShingle | Jonathan Green Colin A O'Keeffe Richard Pilbery Daniel Chalk Madeleine Smith Modelling NHS England 111 demand for primary care services: a discrete event simulation BMJ Open |
| title | Modelling NHS England 111 demand for primary care services: a discrete event simulation |
| title_full | Modelling NHS England 111 demand for primary care services: a discrete event simulation |
| title_fullStr | Modelling NHS England 111 demand for primary care services: a discrete event simulation |
| title_full_unstemmed | Modelling NHS England 111 demand for primary care services: a discrete event simulation |
| title_short | Modelling NHS England 111 demand for primary care services: a discrete event simulation |
| title_sort | modelling nhs england 111 demand for primary care services a discrete event simulation |
| url | https://bmjopen.bmj.com/content/13/9/e076203.full |
| work_keys_str_mv | AT jonathangreen modellingnhsengland111demandforprimarycareservicesadiscreteeventsimulation AT colinaokeeffe modellingnhsengland111demandforprimarycareservicesadiscreteeventsimulation AT richardpilbery modellingnhsengland111demandforprimarycareservicesadiscreteeventsimulation AT danielchalk modellingnhsengland111demandforprimarycareservicesadiscreteeventsimulation AT madeleinesmith modellingnhsengland111demandforprimarycareservicesadiscreteeventsimulation |