By Jen Smith

About a week ago, I received a phone call from a family friend. It was about eleven in the evening. The person was too ill to talk properly, too ill to drive and knowing I am sat at a computer around the clock called me for advice.

Immediately firing up Doctor Google, I asked a few standard questions, found out about the pain medication the person was taking and quickly did some research. During the process, I kept the caller calm, asked relevant questions while I consulted Google, the NHS website and other varying search results. This process took about four minutes. The caller was clearly in great pain and was struggling to breathe. Coupling this with a travelling chest pain and serious pins and needles throughout the body, this was not the time to deal with Dial an NHS 111 Idiot.

Now I am the kind of person who would need permission to phone an ambulance and then apologise profusely for wasting their time. But I realised the situation this time was serious and needed urgent attention. I asked the caller to hang up and I dialled 999. I spoke to the call handler who took all the details and the phone number of the person on the other side of the city to contact them directly.

The outcome of the situation was that an ambulance was quickly dispatched and the caller taken to the ED. This had been a serious situation and urgent medical care was needed.

At Chopsy Baby and on a personal level I receive calls about some of the strangest things. It might be a family member trying to get hold of a skip, or a member of the public wanting to speak directly to one of our advertisers.

Apart from my CV of qualifications, I also appear to have a BA in Commonsense Studies and a MA in Effective Internet Use.

The friend contacted me after being discharged from the hospital. He wanted to thank me. I had to smile at again being used as a more effective way of getting urgent medical care  than phoning NHS 111.

I have had two very recent experiences with NHS 111.

NHS 111 Disaster One

Firstly, at about six in the evening, I discovered my six year old son had thought it a great idea to eat a non-food item. Commonsense told me this was not an urgent emergency. He was breathing, eating and drinking as normal, not been sick and was playing with toys.

As usual when I’m not sure, I had a quick Google. The internet is a wonderful way of getting information up quickly, and one of my favourite sources of information is Mumsnet. The kind of thing you will find is:

AIBU to take my child to casualty he has just eaten a Christmas tree.

You will find around 100 responses. About 50 will say yes you are being unreasonable, my child ate two trees and was fine. Another 49 will say phone your out of hours doctor, and there will always be the one saying, go to the hospital now. My DD did this and turned into a Christmas stocking.

I phoned my GP out of hours service. At this point you would go through to BrisDoc. Someone really efficient would answer the phone, take quick details and have the GP phone you back within the hour according to how serious the problem was and how busy. This service is brilliant. The only problem with it is that you need a car. The service is located at a place you can only drive to. On one occasion, the GP was concerned enough to send a car to pick us up and drop us back.

This kind of use of resources does make you feel guilty, but on this occasion turned out to be important. Care and medicine for a potentially dangerous condition was given without the need for going to the hospital, spreading the germs and putting more pressure on the ED staff. I was very grateful for this service provided and BrisDoc has generally made me feel how lucky we are to have the NHS and access to medical care when we most need it.

Eventually I got the message across. He agreed to have my out of hours GP call me back. That would be one in Somerset. Brilliant, except for the fact that Bristol IS NOT SOMERSET.

I was completely dismayed when I called my out of hours doctor on this occasion to find it replaced with NHS 111. In theory a brilliant idea. In reality a complete shambles. I was left waiting for a call handler for ages. The person I finally spoke to was lovely, but completely out of his depth. It took ages to run through the questions. They were completely unnecessary and the end result was take him to the children’s hospital now. I wasn’t sure this was the right thing to do, but I couldn’t speak to one of my sensible BrisDoc GPs.

By the time I got to the children’s hospital it was busier than usual and I prepared mentally for my four hour wait. When checking in, I apologised to the receptionist and told her that NHS 111 had advised me to come in though I wasn’t completely sure it was the right thing.

There was a collective eye rolling and muttering behind the desk from paramedics and support staff. “We’ve had a lot of these tonight,” she said grimly.

The staff at the Bristol Children’s Hospital were all completely lovely as usual.  But clearly, they were getting swamped from unnecessary visits being sent their way. All I wanted was some quick advice from the GP, I explained. I didn’t think on this occasion it was the right route to get it. It takes about thirty seconds for triage staff to look at my children’s records, nod and say “Oh you have those kind of children.”  I know I do. I have the kind of children where a parking permit and loyalty card is issued on the tenth visit that quarter.

As a parent, and a parent with ‘those kind of children’, you know instinctively how serious a situation is. You know your child and you know when you need to take them to hospital. This didn’t feel right, but with Child Protection the way it is, if someone has advised you to take your child to hospital, it’s best to do so. If you had got it wrong and it came to light that going to hospital was advised but you didn’t go, these are the kind of things that make you look like a social services job, even if you have to unwrap the cotton wool for the doctor to check your child over.

We waited to be seen and the result was yes, GP advice and a physical check had been important. But as far as I was aware it could have been done by the out of hours service.

NHS 111 Disaster 2

Less than a week later, my other child had a fall during the evening and clearly, broke one of her fingers. Doctor Google and experience told me that not much could be done with broken fingers. The child was clearly in lots of pain, but I didn’t want to give Calpol just yet and mask anything that could be worse.

Her finger was swelling in size and going a very dark purple colour. She couldn’t move it and it was causing her some distress. The NHS Choices website advised going to a minor injuries unit rather than A & E. There were possible complications but not enough to warrant using up resources at A & E unless needed.

“Does she have any numbness in her finger? Is she right handed?” It went on and on. “She is two years old,” I tried to explain. “She can talk but she cannot verbalise or understand what numbness is.”

I called my GP out of hours number in the faint hope they may have reinstated direct access to BrisDoc but no. So NHS 11bloody1 it was again. The person who took my call tried his best, but barely sounded old enough to have finished his GCSEs. He was completely clueless as he navigated his way around the system. “Look,” I told him. “This isn’t serious enough to go to the hospital. I am not sitting there for four hours to be told there is nothing they can do about it. All I want is to speak to a GP.”

But I had to go through the stupid poxy questions again. Is she breathing? Does she have chest pain? It was all I could do to hold my temper. “Does she have any numbness in her finger? Is she right handed?” It went on and on. “She is two years old,” I tried to explain. “She can talk but she cannot verbalise or understand what numbness is.”

In the end, he told me to take her to the nearest ED. I could have crawled done the phone line and shouted in anger. I did neither, but I did insist on getting a GP to call me back. I think he despaired and eventually put me through to a ‘clinician’. If the call handler had been unintentionally unhelpful, the clinician was a clown.

Eventually I got the message across. He agreed to have my out of hours GP call me back. That would be one in Somerset. Brilliant, except for the fact that Bristol IS NOT SOMERSET.

After some fumbling around, he managed to find the details of my out of hours GP and arrange for a call back within the next 12 HOURS.

Now let’s be honest. Pretty much anyone who can turn on a computer can do this job. More worryingly was the experience I had with ‘Clinician’ who sounded like he had absolutely no medical training at all and was just reading off the Boots MD website.

Around an hour later, a friendly, wonderful GP from BrisDoc phoned me back. I could have hugged her. Before I could concentrate on what the problem was, all I could tell her was how difficult it was getting to speak to her. She completely agreed and wondered how anyone could keep their patience with the system without shouting and getting angry.

She asked all the right questions and agreed with me. Explained how to splint the two fingers together and what to watch for when it came to potentially problematic compilations.

I couldn’t help but wonder about the role of the NHS 111 Call Handler and Clinician. What are we getting when we phone these numbers?

I found this job description on the NHS Jobs website for the South Central Ambulance Service NHS Foundation Trust.

Person Specification – 111 Call Handler

Essential
NVQ 2/3 Customer Services – or equivalent experience.
Fast accurate typing skills (equivalent to at least 40 wpm).
Good standard of education i.e. English GCSE at Grade C or above and Maths GCSE at Grade D or above (or equivalent qualifications)

Essential
Experience in a telephone based customer services environment.
Experience of using a computerised system.

Desirable
Geographical knowledge of the operational area.
Experience of working rotating shifts.
Previous NHS experience.
Previous experience of patient care.

Essential
Ability to communicate effectively: orally, aurally and in writing.
Ability to prioritise/manage workload.
Ability to remain calm whilst working in a pressurised environment.
Attention to detail and accurate data entry skills.

Essential
Ability to undertake a range of allocated shifts covering 24 hours per day, 365 days per year including bank holidays.
Smart appearance.
Able to meet the physical and medical requirements of the post.

 

Now let’s be honest. Pretty much anyone who can turn on a computer can do this job. More worryingly was the experience I had with ‘Clinician’ who sounded like he had absolutely no medical training at all and was just reading off the Boots MD website.

From the NHS Jobs website, the job advert for NHS 111 Call Handler says: ‘The mission of South Western Ambulance Service NHS Foundation Trust is to respond quickly and safely to save lives, reduce anxiety, pain and suffering.’ I think I would congratulate NHS 111 staff and system for managing to respond quickly to increase anxiety, pain and suffering.

Bring back access to out of hours doctors.