With ambulance services under strain across the country, Surrey Downs CCG has responded by helping to establish a pro-active initiative that ensures those who dial 999 most frequently receive the most appropriate support from primary care providers.

A frequent caller to the ambulance service is defined as someone who dials 999 from a residential dwelling more than five times in a month and 12 times in three months.

South East Coast Ambulance Service (SECAmb) is commissioned to provide ambulance services in the Surrey Downs area. SECAmb’s frequent caller management process uses a four-stage approach to reduce service users’ 999 activity. It looks to shift calls from ‘see and treat’ (where an ambulance attends and either treats the patient at home or takes them to hospital) to ‘hear and treat’ (where they are managed over the phone). The aim is that regular callers’ activity ceases over time – with core needs met by their primary care provider instead.

A Frequent Caller Support Officer (FCSO) for Surrey Downs CCG has been in post since November 2016 and in this time more than 100 frequent callers have been identified in Surrey Downs.

The FCSO has also provided Intelligence-Based Information System (IBIS) training for healthcare professionals in Surrey Downs, enabling them to share ‘admission avoidance’ care planning with SECAmb staff. This assists paramedics with clinical decision making and enables better care pathways for patients.

There is only one other programme like this in the country and it has so far resulted in sizeable financial savings for the NHS – vital at a time when resources are stretched.

Kirsty McMurray, Urgent and Emergency Care Manager at Surrey Downs CCG, said: “This is a great example of the NHS making better use of resources and working in partnership with our regional ambulance service to provide the most appropriate healthcare to people in need. As well as improving the quality of patient care, management of frequent callers has resulted in savings estimated at about £70,000 for Surrey Downs CCG, freeing up clinical time and conveyances to hospital in the process.”

Case study: Albert*

Albert frequently called 999 due to chest pains and anxiety. The FCSO liaised with community teams and the local community hub. As the staff at the community hub knew Albert well, they were able to take calls from ambulance staff who were with Albert to assist them with discharging the patient on scene. This guidance was uploaded on to the patient’s IBIS record and this reduced how often he was taken to hospital. With further input from the community hub, Albert no longer calls 999 and is managed by local community matrons.

Case study: Maggie*

Maggie was an amputee and had very poor eyesight, she was finding it increasingly difficult to get around her home and this caused her to call 999. The FCSO brought her to the local community hub’s multidisciplinary team meeting and found that a number of the team knew Maggie from before her health had deteriorated. They were concerned about the risk of her injuring herself so encouraged her to go into a care home.

However, Maggie wanted to stay in her own home. The team could understand her concern so offered her a short period of respite care to see how she found it. Maggie agreed and was taken to a specialist home that could meet her needs. She was very happy throughout the respite period and decided to stay there permanently. She felt safer, had more interaction with people and was no longer at high risk of injury due to her poor vision and mobility.

* Pseudonyms have been used to protect confidentiality.