I work for 111. AMA

[willingtolearn]

Here to try and clarify some misconceptions about the 111 service. (will also answer q's about the service/not about health issues)

1. There are several different 111s - and they all do things slightly different. They also don't connect to each other - so you should get your local one, but if busy might get diverted - then if you call back your local, they might not be able to see your previous call and you will have to go through the Qs again.
2. Because each 111 does thing differently it can be confusing - questions are usually the same, but timings can be different as can procedures.
3. 111 has several services available - some are for the public, others are for health care professionals. The public service is mostly a signposting service - your needs will be assessed and the end of the questions you will be advised of a service you can use and how quickly you need to access it - anything from asap to 7 days.
4. Different 111s employ a variety of different people that you will speak to - it's likely the first person you will talk to will be a 'health advisor' - they are normal humans trained on the 111 system. You might also speak to a dental nurse, a service advisor (like health advisor but more limited role) or a clinician - who are usually nurses, midwives, paramedics.
5. Most 111s do not have prescribing individuals - some might do, but it is certainly not all. 111 can help connect you to an open pharmacy that may be able to help you with a prescription already issued by a Dr, or they might be able at the end of an assessment direct you to someone who will have the ability to prescribe - often your own GP.
6. Online 111 is a quicker service to use and actually has more options available than the phone 111 - a source of extreme frustration to the staff of 111. It's not available for certain age groups though and you might get told at the end to call 111 anyway (if you're a bit complicated)

That will do for starters - I'll then pop back every so often to answer Qs - as mentioned before I will not answer health queries (best to do online 111 for those or your own GP/NHS website)

have you ever rung 111

I've rung it several times on instruction from my GP reception, when they have had no appointments available. Each time, 111 has redirected me to A&E. Only one occasion actually warranted hospital intervention. So my question is, can 111 do anything other than refer to A&E?

Regardless of the problem, I get redirected to the local walk-in/UTC. It all feels a bit pointless and I may as well begin by going to the walk in and just avoid the 111 bit.

The most recent time they told me that I had an appointment at the UTC. When I arrived the nurses said that they are fed up of 111 teffing people this and they don't actually do appointments.

In my area (anecdatally) it seems like you can't get a GP appointment if you ring the surgery, but if you call 111 you can? How does that work (and why does that work?). What would you prefer people to do - keep trying GP, call 111, use a video appt if available etc? (I haven't used my GP for years and I worry that "how to get an appt" will have changed entirely by the time I next do!)

(On a personal experience, I had to call 111 when I came across a neighbour who was unwell. I had him in my car and I was listening to the ring tone for the whole journey to the local urgent care, queued up there to be told they didn't deal with his type of situation; then it was still ringing (same call) all the way to the local A&E and I only ended that initial call (still ringing) after he had been checked in there.)

Why do you all sound like robots who are bored and obvious that you are reading from a computer? So if a patient is standing, yes they are breathing and no I don’t need to put my hand on their chest. I think we could chat with a bot just as easily?

What’s your role and do you enjoy it?

I’ve heard lots of stories of people calling 111 then waiting many hours for a callback (often people waiting up all night for a call that doesn’t come until 9 hours later). Why does that happen?

Have I ever rung 111 - yes. Did I get what I wanted - no, it was frustrating.

Are there options other than A&E - Yes. Options are - ambulance, EDs, minor injury units,UTCs, GPs,OOHs, pharmacys, dentists, symptom management plus some specialist services such as palliative care. Probably forgot some

Why do they always send to ED? It's designed to be overly careful - because it recognises telephone triage as quite limited and the NHS doesn't want to get sued (more than it already does)

Why bother with 111 and not just go to UTC? If you're happy that's the right place and it's open access - go ahead. 111 is there if you're not sure or if you have to be referred. Same with ED (A&E)

Are there 'appointments' at ED/UTCs - No, there are 'arrival times' - most places this means 'sit and wait' and people are triaged (again) and seen in priority order - some (few) places do actual have systems that allocate people to times.

Why does my GP say I can't have an appointment but I can if I call 111? Most GPs now have some sort of triage, often quite similar to 111, but if they don't they use 111 to act as triage - if system returns GP - we then look for appointments - often telephone callbacks (no times) - the GPs (and other services) choose what they offer and can turn it on/off

Why do we sound like robots? Because saying the same thing over and over and over again is quite dull. Don't worry, AI will come in soon enough.
Putting your hand on the chest is to check for warmth and rule out life threatening shock. All questions MUST be asked (and generally exactly in the words provided)

Prefer not to say my role. I am not convinced that 111 is a great use of NHS resources so generally frustrated with it.

Callbacks - can be by our staff or externals - like GP OOH. It's a 24hr service so you could well be called in the night. How long it takes depends on how busy it is and how long each call takes. All services call back the most urgent calls first - which keep coming in and shifting other less urgent calls further down. Also depends on staffing - fewer staff = longer wait.

If it were up to you, how would you improve 111?

To improve 111

1. Make it national - don't make the different one's compete for contracts. Have one set of standards and practices that everyone uses. Make sure all records are accessible to all services - so no duplication of effort.
2. Continue to develop the online service. Use the online service for individuals with language requirements - it is easier and cheaper to provide information in different languages written than spoken.
3. Make online and telephone 111 match up - I can not see why online has so many more options than telephone - example blood pressure issues - very very common, ultimately GP issue and should be a fairly short assessment (it is online) whereas telephone 111 will only accept symptoms (when evidence shows blood pressure measurement does not correlate to symptoms)
4. When next updating - actually correct the 100 different things that need changing - instead of telling advisors to remember these 100 things that are wrong and have been for years - example 'appointments' is what comes up on the system but they are not appointments 99% of the time - they are simply arrival times. As noted above - if you train staff to read the words exactly, this is what they will do.
5. Not just 111, but the NHS in general need to have a conversation over risk appetite and how many resources they are willing to waste to limit this.
6. Deal more robustly with the regular callers - the ones who call 10 times a day, daily - there is a process, but it is incredibly slow and can take years to stop them - mulitiple millions of pounds are wasted by this
7. Improve the message that people get at the start - tell them what 111 is and what is going to happen next - manage expectations.
8. Campaign to improve both HCP and public knowledge of what 111 can do and what it can't - HCPs regularly tell people to call for something that cannot be done by 111.
9. Give the experienced staff more flexibility - the rigidity of the processes may reduce the risk, but tend to really irritate people and make them feel less listened to. After the 1st year, most staff have a good idea of when flexibility is needed.
10. Involve the staff who are actually taking the calls in developing the service/questions - they will provide valuable feedback about how people perceive the service and how they answer the questions/what the difficulties are. Pay them to do this, don't expect them to do it in their free time - management get paid for it.

There's more but that's enough for now