Caring for frequent callers

We use a nationally agreed ambulance definition of a frequent caller:

A patient aged 18 years or over, whose calling, from a private dwelling, generates 5 or more incidents in a calendar month. In this context, ‘incident’ means hear and treat, see and treat, or see and convey.

Some callers can exceed this threshold, calling 999 several times a day.  Although relatively small in number, prolific callers can make it harder for us to reach others with more serious or potentially life-threatening conditions.  However, we also recognise that frequent caller patients will often have complex health and social circumstances which require us to work closely with local health and social care colleagues.

London has a population of over nine million people. Of this a tiny fraction meet the definition.  Each month the Frequent Caller Team identify round 300 people, who are new or existing frequent callers.  Some of these patients may be long term callers with entrenched behaviour that cannot be resolved easily, involving a lot of work behind the scenes over many months or years; others will be new or emerging patients where early intervention could help avoid the frequent calling behaviour from becoming more established.

The 999 system is a simple and free number to call. It is often the only number known to the caller and may be a ‘cry for help’. Calling may also mean the start of alternative help and support being given.

There is no one common factor linking all frequent caller patients.  There are often complex behavioural, mental health, social and clinical factors that may result in frequent calls, sometimes with histories of complex trauma.  However, there are some common themes:

• Chronic medical conditions
• Mental health issues
• Learning disabilities, neurodiversity, intellectual disability
• Physical disabilities
• Substance abuse & dependency
• Older people with associated health conditions
• Hoax/vexatious callers (an extremely small proportion of frequent callers)

The Frequent Caller Team has developed a proactive approach to addressing the individual needs of the patient and achieving positive outcomes for both them and our service.

The Team works closely with our internal colleagues at LAS including the Safeguarding team, Mental Health team, Quality Governance & Assurance Managers, Patient Experiences Department, Systems Partnership Transformation Managers, the Clinical Hub and the Medical Directorate. The Team also works closely with our external partners.

The team attends a wide range of Multi-Disciplinary Team meetings (MDTs) which may result in a care plan, created with the patient and their support network. The team works with local Emergency Departments, Social Services, Community Mental Health Teams, community social prescribers, GPs, housing officers and other partners involved in the care and support of these vulnerable individuals to try and ensure their unmet needs are supported.

The team attends Frequent Attender Forums with emergency departments & other agencies across the capital and London-wide High-Intensity User forums. At these meetings, teams examine cases of complex and challenging patients, hospital attendances and any reductions in conveyances. Our team uses these meetings to highlight best practice and contribute data and learning concerning impacts on ambulance services.