Box 1 Example of variation between areas within one service

Aim – to discourage people classified as Frequent Caller from further calling

Actions for callers meeting defined threshold:

• Clinical Support Officer (CSO) contacts patient by letter stating they have called the emergency ambulance service more than normal and should seek help from their GP, contact number provided within letter for patient to talk to ambulance service manager; and calls or sends letter to GP to make them aware patient is calling the emergency ambulance service frequently

• If calls persist, CSO may contact other services to intervene and support patient

• CSO writes individual care plan which is shared with the call centre clinical team. When the patient calls (s) he is triaged to a clinician in the call centre rather than sending an ambulance

• If caller persists then (s) he may be referred to the police and court

Aim – to identify triggers which lead to the patient making the call e.g. adverse childhood events, mental health, drug and alcohol dependency

Actions for callers meeting defined threshold:

• CSO speaks to GP or practice manager first

• Patient is discussed at monthly MDT meeting. Around 50 patients may be discussed at one meeting, 10–15 of these making high use of ambulance service. MDT is used to provide a network of support for the patient and to address their needs through multi-agency working. Professionals see it as part of their role to support people who frequently access the ambulance service, police or ED. Agencies involved: police, ED, Out of Hours primary care, voluntary sector, social services

• Patient allocated to appropriate agency to lead on care planning and provision. A care plan is created and shared so that any agency contacted by the patient knows what has been agreed

• Patient interviewed individually to assess need

• If calls persist or patient has an anti-social behaviour order, the CSO visits the patient along with a police officer or representative from the ED