Directory of Services
What is the Directory of Services?
The Directory of Services (DOS) is a central directory - which is integrated with NHS Pathways - provides the call handler with real time information about services available to support a particular patient.
For example, the clinical assessment within NHS Pathways gathers information that indicates the specific clinical skills needed by the patient. This information is used to perform a search on the directory to find a service local to the patient, which has all the clinical skills required.
The services that appear to call handlers on the directory are set in the commissioner's preference order. These services are offered to patients at the end of the assessment and can be referred into - providing they have the appropriate clinical skills required, in the timeframe needed for the patient. For example, if commissioners prefer that callers are directed to a nurse led walk-in centre (where available), then to GP led urgent care centres and A&E departments, those services that match the patient's needs will be presented in that order.
Call handlers are trained to offer the service at the top of the list first, then to move down the list if patient choice indicates another preference.
The Directory of Services can be searched in two ways:
- Automatically via an assessment using NHS Pathways. Completing the clinical assessment produces a unique combination of codes, these identify the clinical skills required and the time frame within which they must be provided to the patient. This forms an electronic search string which returns results directly to the screen of the call handler.
- Manual Clinical Search - a search instigated by a clinician. A web screen enables a clinician to enter the age/gender/location of a patient and to select the clinical skills they know the patient requires. For example, a GP on a home visit or a district nurse can access the search screen and find a service to provide particular skills. This search returns the same list of services as the automatic search would generate.
Integration with NHS Pathways
Although the Directory of Services is a standalone product, it works best when integrated with NHS Pathways. Whilst the call handler is assessing the patient via NHS Pathways, key answers are determining the skill sets required to treat the patient. At the end of the assessment the Directory of Services presents the call handler with a list of appropriate, available services close to the patient's home.
NHS Pathways and the Directory of Services – Support for Commissioning
As every search is captured, the reporting within the directory enables commissioners to identify the demand for particular skills. It also enables commissioners to see which services were available to deliver particular skills, and crucially, which services missed by one or two criterion. For example, if a particular service met all needs but was not open at the right time, this data can be collated to see how many additional referrals the service would get if it extended its opening hours. This allows commissioners to change local service provisions. Additionally, if patients are being sent an ambulance or to Accident and Emergency for certain health issues that can be treated in the community, commissioners are able to analyse the data from the area and commission services to meet the demand.
Importance of the Directory of Services
The Directory of Services provides a means for a clinician to search for and identify another clinician to whom their patient can be referred.
- It can maintain auditable records and provides detailed gap analysis for commissioners. This gap analysis provides the evidence on which to base future commissioning to maximise their effectiveness and ensure that appropriate services are available to support patient care.
- The Directory of Services is able to support unnecessary hospital referral by presenting a range of more locally based services to manage unscheduled care.
- The Directory of Services can be integrated with NHS Pathways, allowing consistent clinical assessment and an automated directory search for 999 call handlers allowing instant access to available services.
- It supports direction of the patient to the right place, first time for care.
Benefits for commissioners
- The data held within the Directory of Services is detailed enough to present the most appropriate service for a specific patient, based on where they live and their registered GP surgery.
- The Directory of Services presents a range of locally based services that can manage unscheduled care. Having this information to hand can help to reduce 999 calls and unnecessary journeys for patients to Accident and Emergency departments.
- The list of services are displayed in a manner that ensures that the most appropriate and cost efficient service is always listed first (as long as the correct clinical skill is available in the time frame required for the patient).
- The list of services can be displayed in commissioner preference order, ensuring that the most appropriate and cost efficient service is always listed first.
- The Directory of Services is able to avoid unnecessary hospital referral by presenting a range of more locally based services to manage unscheduled care.
- Real time reports are available from the Directory of Services which can inform commissioners on what services have been searched, accessed, referred into by time of day and location.
Benefits to service providers
- Appropriate patients can be directed to the specific clinical skills that the service can provide.
- Primary care service demand can be viewed in a red/amber/green format. This will help call handlers to move the demand around healthcare providers and avoid unnecessary delays in emergency care.
- By updating the availability at a service the flow of patients can be managed on a real-time basis.
- Service providers can indicate online to referrers if they are very busy and for a time period unable to see any more patients.
Benefits for patients
- The Directory of Services enables patients to be directed to the appropriate service for their symptoms so they get the right care, first time.
- If a patient calls an out-of-hours service using NHS Pathways for triage, an ambulance dispatch can be carried out (if necessary) in no more time than if 999 was called directly.
- Patients will only need to give information about their symptoms once, as the captured information will be shared if another service is required. E.g. if the patient was referred to a primary care service.
Third party supplier connections
Can third party applications search the Directory of Services (DOS)?
Any third party application(s) wanting to search the DOS must do so via an NHS Organisation. There are two stages to the process of gaining approval from NHS Pathways for the third party application to connect to the DOS:-
- The third party should complete the Service Brief Template (DOC, 46.5kB) in order for the application to be technically assured and email the completed form. The information required includes a service overview, projected usage, mechanism for connection (e.g. web service) and system architecture.
- Once NHS Pathways have confirmed technical assurance, then the lead contact at each NHS Organisation wishing to subsequently deploy the third party application should send an email to Pathways.ServiceDeliveryTeam@hscic.gov.uk, requesting access for their organisation and providing details on their reason for requesting access, volumetric, scope of usage & pilot/roll-out plans.
The applications are on a geographic area basis, and not on a supplier basis. If a supplier has permission to search the DOS for one area it does not guarantee permission for other areas to search.
The key is to safeguard the availability of the DOS for 999/111 access and therefore the volume of calls on the DOS will be closely analysed before permission is given.
To date, one supplier has been given permission to search the DOS for 2-3 pilots, covering very small geographic areas. Any area considering the use of a third party application to search the DOS needs to ensure their project has specific permission.
We are currently unable to approve large scale use by any area until we have implemented a mirror DOS infrastructure, that will be the receiving point for all such searches. This will ensure we can safeguard the availability of the DOS for 999/111 use, in the event that there is a surge in other types of search.
Implementation of a mirror DoS is currently underway and due to complete in September 2014, we will provide further updates on this in due course. If you have any questions about the above please get in touch via email.