1 December 2023

QI case study: Improving access - iCaSH telephony

Peering over the shoulder of a man in a phone call centre with a headset talking to a service user. Next to him is another call handler taking a call.

What is a QI Case Study?

Case Studies invite you to explore invaluable insights through a collection of compelling improvement projects from across the Trust. Read below for a quick take on how the Cambridgeshire and Peterborough iCaSH team developed their telephony systems to improve access to the service.

Improvement Name: iCaSH Telephony - Improving access into the service

Date: December 2023

Deep Dive: Understanding the Problem

The challenge:
High volumes of calls into the service with approximately up to 50% of calls unanswered. As a result, all 6 localities experienced service user frustration, staff stress, complaints and the service's inability to achieve their commissioning commitments and performance. Most of these calls are concentrated between the hours of 8am-10am, which causes spikes in demand. Furthermore, the telephone number acts as a single point of access/is the only access route into the service.

Broad analysis:
A deep dive into the problem with multi casual factors identified that by addressing the unanswered calls alone would address the underlying root cause problem, the lack of appointments. Callers are asked to call back if appointments are not available, creating a cycle of repeat callers 'artificial demand' into the service.

Unveiled data insights:
Analysed demand and capacity.

Engagement:
Co-production (Friends and Family test feedback, contacts logged with Patient Advice and Liaison Service, and online focus groups), brainstorming exercises, workshops, surveys and Task & Finish groups.

Learning:
Gathered and reviewed learning from best practices across 6 localities.

Design: Designing the Change

Clinical Nurse Managers and Service Managers were invited to join workshops to share best practice. This provided a platform to explore improvement initiatives being undertaken across localities, design processes and pilot new initiatives.

Brainstorming exercise was undertaken to explore and generate improvement ideas.

Deliver:

Innovation and support:
Variation in processes across localities provided an opportunity to capture best practices and share learning. Task and Finish groups set up and case studies shared to support localities with implementing proven effective initiatives.

Both Cambridgeshire and Norfolk centralised merged their phone lines for their clinics

Enhanced monitoring:

Developed a real time telephony reporting platform to better understand call flow through the 0300 number.
Developed modelling tool to estimate expected call answer rate based on number of agents as well as iCaSH telephony simulation tool.

Increased capacity:
Increased training for external staff e.g. GPs, Practice Nurses, Midwives, Physicians Associates to provide LARC services in their areas of practice.

Evolve: Continuous Improvement

Post-implementation review scheduled following BT platform rollout to review impact.

Lessons Learnt:

Sustainability for initiatives to continue impacted by staffing availability. This varied during the project.
Independencies with clinical-based activity became increasingly apparent. As a result service wide SOP is being developed further to standardise clinical elements.
Cambridgeshire struggled to recruit due to temp/fixed-term limited contracts.
Mpox Virus(MPV) had an additional impact on capacity - service provided vaccination programme.
Country strikes i.e. postal strikes, nurse strikes, teachers strike - impact on service: lack of staff, delay in patient results, posting of patient medication and online test kits.

80% of callers can get through to an agent (August-November 2023).

100% increase in clinic availability (from 6-12 appointments daily).

24 Kings Chambers clinic went from offering 7 appts to 24 for repeat contraception.

45-minute face-to-face appointments for one-stop procedure implant clinics (previously 30-minute phone assessment followed by a 30-minute face-to-face procedure slot - Norfolk).

You can find more information about the iCaSH service and their QI snapshot below.

Download the full Case Study here

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Last reviewed:

1 March, 2025