I'm a 111 call handler AMA

[111callhandler]

I see lots of threads where people say how crap 111 is. I thought maybe people wonder what goes on the other end of the phone...

[Mishappening]

He kept trying to tell them what was needed and getting nowhere.

[Mishappening]

By the way, my OH is a retired GP.

[Mishappening]

Last week I called 111 because a district nurse refused to deal with my (very sick and disabled - totally helpless) OH as he was in excruciating agony with a major bowel blockage, so much so that when I rang 111 for advice they called an ambulance. Out came 3 para-medics and decided he did not need hospital, but simply a doctor to do a manual evacuation. They finished up ringing the district nurse (same reply) and 111 themselves! We got a doctor in the end, but so many people had wasted so much time over something that was so very simple.

[111callhandler]

That is the official line with us too but I always ask if we can skip the nurse advice bit if it's a nurse or a doctor on the phone as it seems pointless to me. Usually they oblige but sometimes there's other stuff going on behind the scenes that means they can't. One of our areas had no ooh GPs yesterday for example. So before sending people to A&E or miles out of area they were nurse assessing as much as possible.

In your example they weren't making it more difficult because you were a hcp so I don't suppose it matters if you told them or not.

[winesolveseverything]

I once made the epically poor decision of telling them I was an off duty hcp, when I called for an appt for my sick baby. Because I was off duty the call taker (with no medical knowledge at all) told me it didn't matter that I'd assessed my child and I couldn't just have an appt- it would be down to the nurse and then the doctor to call me back and decide whether I needed one or not. 🙄🙄 8 hours later, when we had returned from A&E they finally phoned me back.. Still livid to this day. (And yes, of course I had chased it up)

Didn't make that mistake the second time. I told them I was on scene with my a sick child- immediately given the appointment... Does it honestly matter that much as to whether I'm wearing a uniform or not??

[111callhandler]

Fatberg, only once! I think it was a lady that got bitten by a lion. It would make a change from the dog bites we get lots of calls about!

Decormad, we challenge them more than the callers. We would never diagnose over the phone either so we'd never tell someone they were having a heart attack. If callers do challenge the outcome I almost always get a second opinion from a nurse advisor. The most commonly challenged one is A&E I suppose. Nobody wants to go there and wait for hours which is fair enough. We always tell people we can only advise them, it's up to them if they take that advice.

1sttime, I'm glad it worked well for you. And yes, under 5s have a completely different set of very sensitive algorithms where it would rarely come up with a wait of more than 2 hours. Less than that for under 3s and then less again for under 18 months.

[1sttimeunicorn]

I know it's probably not a commonly held opinion but as the mum of a 2 year old I have found the service to be brilliant. My son recently had an episode on a Saturday (it's always weekends!) where he spiked a very high temp of 41 and went a funny purple colour on his hands and feet. I rang 111 and 25 mins later we were met at the hospital by a registrar. I couldn't get over the efficiency. Turned out to be a nasty ear infection. So yeah that's not a question, but I've always got the impression that they don't take chances with little ones.

[Decormad38]

My DH rang up once because he needed an out of hours appointment and it was the only way he could get one. The call handler told him he was having a heart attack. Im a nurse and said no way is this a ruddy heart attack! He had originally rung up with a migraine. Question is: do you get challenged about your over simplistic algorithms?

[TheFatberg]

Do you ever see any Mumsnet threads about someone calling 111 and hope you get the call?

[stillworkingitout]

Thanks OP. He’s fine, and he’s 3. He had a uti but the questions were geared up to older babies and children. Really the fever of 38.5 should have been enough for them to tell me to get him to a&e. In the end I had a call back at about 7am (8hrs) later where someone (a dr) gave me a bollocking about how I should have just taken him to a&e anyway. By that time he was already on IV abx. This is on the south coast of England. In 2016.

My other brush with ooh was for a child with lymphadenitis. 111 were helpful then but the ooh gp insisted viral. 36h later again on IV abx and in the early stages of sepsis. That wasn’t 111s fault though.

[111callhandler]

Mishappening - I can see how that can be frustrating. Call handlers 'prioritise' the call so we do have to ask a few questions to do this. The answers are recorded but I'm not sure what happens when a nurse opens the call and why they have to repeat it. I know they have their own algorithms to run through and I expect our system isn't sophisticated to populate them with the call handler answers.

Sd1978 - it can feel like that. I'm pleasantly surprised by the nice comments here, I expected a kicking if I'm honest!

Indian, I think they are but I've only experimented with one symptom so I can't say for sure. I don't know the official answer - I'll try and find out.

Still working - that wouldn't have happened with our service. A baby that young would only have a callback within 20 minutes. It's very cautious with newborns. Just a few questions and the outcome of a high priority callback. I'm glad you followed your instinct and I hope your little one is well now.

Frankie I hear that a lot. I'm fascinated with how other 111 services work. I can honestly say none of your examples would happen here. Perhaps because we are part of the ambulance service. In fact we get their green calls sent through to us regularly. We get a lot of people trying to demand an ambulance and when we refuse they ring for one themselves only to get diverted back through to us!

Thismust. We are encouraged to question and seek advice so don't stick doggedly to the outcome if there are obvious indicators that it's incorrect. Of course not even our nurses can diagnose over the phone though so if there's a headache that could be sinusitis but hadn't been diagnosed I guess that's a hard one to call?! I don't know.

Thanks to jellycat and Teddy for your kind words. I actually listen to my colleagues dealing with some tough calls on a regular basis - it's not uncommon to have to talk down/keep talking to someone who is suicidal. I think we do a good job and that's not often recognised so thanks for noticing!

[ThisMustBeMyDream]

As a midwife on the triage phone line and dealing with then as they walk through our doors, 111 cause me so many problems. Sending a woman with sinusitis to a maternity unit because she ticked the 'having a headache box'. She had a headache which worsened on standing and sitting, and all the other sinusitis symptoms. She was sent to triage and wasted many hours unnecessarily. We can't issue prescriptions for that kind of issue. She needed a GP appt! Instead she was sent to a totally inappropriate service who ultimately could do nothing to help.

Also, when you just want an out of hours GP appt and have to ring 111. Just ARRRRGHHHHHHHH.

[FrankiesKnuckle]

@winesolveseverything 🍷

When you hear the constant broadcasts for proper jobs and you're stuck on a cat1 bellyache - one job at a time lovely 😊

[winesolveseverything]

Frankiesknuckle... you are right...

111 was brought in to alleviate the workload of 999- instead it has tripled it...

Just the other day, we were responded on blue lights and sirens to someone who had taken their evening tablet 2 hours early... 🙄
Another person who had a mouth ulcer..

Common sense does not prevail anymore.
And nobody wants to take any responsibility for themselves... The entire out of hours system needs overhauling.

I could rant all night but also just had a crap set of weekend shifts so will shut up now....

[FrankiesKnuckle]

@JellycatElfie working a 12 hour shift on an ambulance when all you get is bollocks 111 calls when there are calls holding for genuine medically unwell/injured patients then yes it's the bane of our working lives.
IME 111 over triage an awful lot.
Sadly 999 can under triage.
Public education and self care is the way forward for the worried well.

I've had a crap set of shifts so just venting.

[teddy275]

Thankyou. 111 has always steered me in the right direction and the call handlers have always been very calm, friendly and reassuring - even at times where my anxiety has gotten the better of me and I've not been very calm myself!

[JellycatElfie]

Yes, I should’ve said thank you too. I’m a nurse so it can be frustrating when 111’s algorithm tells me one thing when I know what needs to happen. The call handlers have always been so lovely and they really do try their best. I don’t think 111 is the bane of the ambulance services life either - the algorithm needs to be over cautious else the nhs would be slaughtered for ‘missing ‘ something. The people to blame are those ringing 111 when they need to apply common sense.

[FrankiesKnuckle]

I've had too much 🍷 😁

[FrankiesKnuckle]

111 are the bane of the ambulance services life.
Not your fault personally obviously, but really! It's the algorithms - belly ache after eating gone off chicken, well it's obviously a triple A! Disregard the 90yo #nof on the floor for 4hrs... gah - been a long assed set of shifts 😕

I know you deflect a great deal of other shit away, for that thank you - I for one could joe listen to the shit that some people spout in the phone!
(Just have to deal with it in person instead 😁)

🍷

[stillworkingitout]

Are you confident in the algorithm’s ability to deal with the very young? I’m unconvinced after waiting 8h for a call back for a days old baby with a severe infection. If I hadn’t followed my gut and gone to a&e we’d have lost him. The system just didn’t seem to cater for his problems. The call handler just kept asking me if he was responding to his name (which we hadn’t decided at that point).

[111callhandler]

I'm at work now and on a break so will answer what I can before I have to go back!

The job is OK. It's repetitive but the callers are mostly nice.

Dental pain is the most common. There's a real shortage of NHS dentists in our area

No medical qualifications at all.

We did some first aid training but nothing extensive.

I do disagree with the algorithms sometimes but we have nurse advisors walking the floor who we can consult with to change the outcome.

It is a bit like a flow chart I suppose - you select a symptom and go down a series of related questions.

I'll have a think on the ridiculous question!

You're welcome bastard. Most of the callers are lovely and it's a pleasure to help them.

Break over - I'll be back!

[indianbackground]

Are the answers from the 111 online process likely to come to the same result as calling?

[SD1978]

I do a similar role in a different country. Good luck with the questions! It's a pretty thankless job at times!!

[Mishappening]

Why do you go through a long list of questions, only to say someone will ring back and that someone asks all the exact same questions over again?

[BastardMozzies]

Thank you for being kind, listening and telling me what to do.