I’m a 111 Clinician ama

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I’ve name changed for this as I don’t want it linked to my regular posting. I’m currently doing a temporary stint in 111 as a clinician so I’m one of the people who calls you back after you’ve been triaged by the call handler. As you can imagine it’s a bit busy at the moment.
I’ll do my best to answer any questions as accurately as possible.

Not sure why it went bold! I'm not that angry!

Was the call audited? People do say 111 told me...when they may well not have done.

hiphopapotamuses Please get it checked out to make sure you haven’t ruptured your Achilles’ tendon. It can just happen with With the ‘wrong’ movement and a pop/bang is a very normal symptom (happened to me a few months ago so I might just be paranoid). I knew I hadn’t sprained my ankle but thought I’d badly bruised it. Could walk (kind of) was eventually made to go to the doctor after about 10 days, who sent me straight to A&E who confirmed it pretty quickly.
Hope it’s not that!! but definitely worth getting checked out if it’s not recovered after that length of time.

I don't know - I gave up form filling for incorrectly triaged calls/inappropriate sends a long time ago. I had no reason to disbelieve the patient in front of me, seemed totally genuine and actually very apologetic that we were sent in the first place.
That turned to mirror our anger when I informed her that we didn't perform any kind of US or TVUS!
She only called to find an open EPU!

Could you please attach links to the best sites for CV advice?
Do you think most people need to be calling you or could they fine the answers they need on the sites you (hopefully) recommend?

Paramedics are so cool! Do you feel cool? I always thought it would be such an interesting and challenging job! Thanks for your hard work!

Also wondering if I’ve ever been in an ambulance with you

Roughly what percentage of your calls this week have been about Coronavirus?

Do you do you just do 111 or any 999?

And how call centery do you find it? By which I mean - do you have to minute your toilet breaks / time off the phones? That kind of thing?

I got offered a job there once (RMN) and I thought it would be interesting, they offered either 999 ambulance triage or 111 or possibly a mix but the shifts were awful. Long shifts not long enough so more shifts per week than I'd prefer and so many weekends! (Lots of unsocial hours pay though I guess )

My son was born with a floppy larynx and with him team at the hospital we made a care plan about when to go to hospital or gp but often out of Hours would send a ambulance for him when he didn't meet the need to go ( with his care plan) and despite we saying no he doesn't need it he needs a gp appointment they wouldn't listen. Do you feel like you have enough access to health records? As I felt like 111 didn't with my son

Do the 111 call handlers ever say 'no action required', or is the minimum response always to be seen by primary care?

Cool thread OP!
I'm one of those that hates to bother emergency services (police officer so I know how pressured you are)
Last summer a ladder broke from under me , I fell 8 feet onto my back and was screaming in pain, completely immobilised.

DH comes out, saying he'll call 999 and I'm all 'No, no, call 111, they're too busy'
So he calls 111 and they can just hear me screaming, I can't even move a finger without wailing in agony. They get an ambulance out on a cat 1, the paramedics found it very amusing I'd call 111

Thank you for your service!!

Posted too soon.
Turns out I had a fractured vertabrae! The paramedics were lovely and even came to see me on the ward the next day.

My question - do you get a lot of hoax calls, or people with hypochondria etc? How do you deal with them?

Ooh just who I want to talk to! Do you ask the patient coronavirus questions before you send 999 calls to difficulty in breathing jobs?

Sorry for not being on the site, been very busy as I have been tasked with dealing with just the suspected COVID callbacks, very busy as you can imagine
@KenDodd The NHS websites and gov.uk are the best ones with the most up to date info.
@Mandatorymongoose I just do 111 but not answering calls, just calling people back to do a clinical assessment. It certainly doesn't seem call centre like, I sit opposite call handlers and they seem to go to the loo as much as I do. They are targeted on how many calls they take but seem well supported. Our 111 services are run by our ambulance trust so it may be different when they are run by private companies.

@Whome91 No I don't feel we have enough access to care plans but people can always refuse ambulances and ask for a call back from a clinician, in our area we have paeds nurses who would probably be much more experienced in those type of conditions. Remember call handlers cannot change the disposition they get from the algorithm unless the caller refuses that disposition.
@WaitrosesCheapestVodka Yes calls do get the disposition no further action but that is not the call handlers decision, it is the disposition the algorithm reaches based on answers to specific questions.
@BasilFaulty You'd be surprised at how many calls slip through and on careful probing you want to say 'why the fuck did you call 111, you need 999' Fairly major falls, severe breathing diffs and acute chest pains being a few of them. Elderly people stuck on the floor is a favourite, their carers call 111 despite notices going out to care agencies and nursing homes.
We do get a lot of 'worried well' most just need reassurance, old and lonely people need a chat and a cuppa that someone else has made for them.I make lots of tea and toast. Hoax calls are not that common but the ones we do get tend to be fake paed arrests which are very distressing for staff as you get hyped up enroute.
@Purplewithred I don't answer any calls, either 999 or 111 but I believe the questions get asked on all calls. I'm just doing the COVID call backs at the moment and it's not the most interesting job!

Apologies if I've missed anyone, I'll pop back at intervals but I'm going to enjoy my day off while the sun is shining.

Not a question, but a thank you. As a pp said, 111 get a lot of flack, but they've always done well by me.

There have been three occasions when 111 have managed to get my daughter an out of hours appt on a Sunday afternoon (always a Sunday...never a week day morning) when her temperature has spiked through the roof (she's one of those who goes from 36.4 to 40' at the blink of an eye).

One of my staff says she called and has been refused a test. She says she is to isolate for 7 days, I’m not wanting her to return for 14 in case positive. But how would we know? Do we need to isolate as we are In contact with him?? He has been travelling not to Italy but through London and USA.

No there is no testing apart from for those who are admitted to hospital. Current advice is only to self isolate for 7 days if you have symptoms of a persistent cough and/or a fever of over 37.8 degrees.
If she is not admitted to hospital, and the vast majority aren't, then you won't know if she is positive.
Out of all the people I spoke to who were symptomatic over the last three days only one needed an emergency ambulance, the rest had temps, coughs and generalised aches which can be managed safely at home with good safety netting advice. Many were already recovering but have a bit of a sore chest due to coughing which is why they made their way onto my queue.

@ThinkPinkStink Thank you. that means a lot.

I don't mean this to come across as rude as it may look (honestly! ), but what does "clinician" actually mean? Are you a doctor or otherwise medically qualified? Do you actually diagnose or simply follow flowcharts on a screen? Why does so much seem to end up with an ambulance being called when the shortages in the system are already so bad?

Op said they were a paramedic, read the whole thread Buzz

I'm a registered paramedic with over ten years frontline experience as I stated up thread. And no I don't follow flow charts, I use my clinical experience and judgement. The ambulances generally happen because it has never reached the stage of a clinical call back, if we cannot call back within 30 minutes and the caller has not refused the ambulance then one will be sent. These are NHS England rules not ours, sometimes the time gets stretched but generally that's the case. things are a little different at the moment as these are strange and unusual times.
I can stand down an ambulance if after my assessment, and in my clinical judgement one is not needed.
At the moment fewer are being sent because more people are refusing them as they know they don't need one and their chest pain is from coughing so much. They're generally right.

Have they given you a reason as to why they won’t test folk now? While the rest of the world are ramping up the testing procedures to cover more and more people? Seems like our numbers are being controlled instead of reported accurately. It’s just a bit bizarre, telling someone to stay off for 7 days who “could” have coronavirus then returning if symptoms are still present could end up killing me (with athsma) or other colleagues if they are contagious!

The general opinion is that it is very expensive to test everyone who shows symptoms. Other countries that are testing generally have a differently funded health service and perhaps don't need the additional funds as much as we do. It also doesn't change the treatment at all.
I really don't think there is any sinister reason behind it.

Is your management a clinical trained team? When new changes are made (ie corona virus) are these made by a group of clinically trained managers or is it more of adhereing to the decisions made by people such as politicians?

I'm a registered paramedic with over ten years frontline experience as I stated up thread. And no I don't follow flow charts, I use my clinical experience and judgement. The ambulances generally happen because it has never reached the stage of a clinical call back, if we cannot call back within 30 minutes and the caller has not refused the ambulance then one will be sent.

Thank you! Very interesting to know the inside track and also the bit re ambulances.