If you work for the 111 service can you answer my question?

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A thread I've just read reminded me something that happened recently.

My dd was complaining of earache which had gone on for a week so I tried to contact my surgery out of hours. I didn't realise I had been put through to the 111 service. I thought out of hours and 111 were two seperate numbers.

Anyway, I explained everything and was just after some advice on how I can treat her at home.

Waited for a call back. They called back at 2am. Basically demanded I go to a&e. I couldn't as I didn't drive then and had very young children. I had no babysitter on standby. The lady on the phone basically said she would have to pass this on to SS if I didn't go to a&e.

Dd was now fast asleep too.

Eventually after I ended up breaking down crying she booked me in at the out of hours for 7:30 the next morning.

If you work as a caller for 111 why do you feel you need to threaten us when we just want advice.

Just to add I will never call them again.

This happened to me too and is why I haven’t called them in years.

Mine was a child with a banged head. I just wanted advice. Instead they insisted I go to A&E which is over an hour away. I was 30 weeks pregnant with a 1 and 2 year old and it was nearly their bedtime. DH was working away.

They said that A&E were being told that we were coming and if we didn’t attend then SS would be informed. Twats.

@Not111 sorry this happened to you too. I felt that they thought I was just making up excuses but at 2am it's not easy.

What advice were you hoping for if you needed to take your child to a and e? It sounds unkind to make a threat, but I guess they were saying 'our algorithm says if you don't get medical help ASAP the child might die'. Would you have preferred to hear that? And would that have changed your actions? It's really not relevant what time of day it is or who's bedtime it is.

I was advised to go to A and A by 111 this week because if chest pains. I didn't go. I wasn't in any way 'threatened' perhaps it's different with children.

This also happened to me.
I told them I had no symptoms, but had been asked to call (long story).
They said if I wouldn't go to a&e then they'd send an ambulance.
Ambulance came 8hrs later.
Ambulance wasn't allowed to leave as I had slightly raised BO (after all that what a surprise!!??)
4hrs later...
Out of hours doctor came - stayed less than 10mins whilst muttering I was fine.

A classic example of waste of resources and not listening to patients that know quite a lot about their illness as they live with it 24/7!

Raised BP!

And I forgot about the SS threat too as I "wasn't making a reasonable choice"

Its because they follow an algorithm thats highly sensitive and risk averse. Im an A+E nurse and we get people who come into us all the time because they've been advised to by 111. They usually dont need to be there.

It sounds as if the person you spoke to needs to work on her manner down the phone a tad though

What does 111 offer over ‘Dr Google’? It is manned by ‘trained’ operators reading a screen with a basic algorithm.

If you have half a brain and google your symptoms, you can obtain the same (with a decent understanding, better) results.

It is amazing that proper medical care has been replaced with this..

It's cheaper than proper medical care, that's why.

We did have NHS 24/7 which was staffed by clinicians. 111 is staffed by call handlers following scripts and their basic training. They should have access to real clinical advice on site though.

I think 111 is half the reason A+E is so clogged up. Would be interesting to hear what A+E staff think of it.

Our GP used to say "they always send you somewhere".
That was when they told me, MN style, "A&E now!"

This was because I'd phoned to ask for advice as dd had antibiotics and thrown up immediately after taking it, and I wanted to know if I repeated the dose or left it till the next one. (if your interested the answer is you can repeat it)
I told them I would go straight down to the GP, 2 minute walk away and see if they'd see me.
I did, explained why. GP saw me.

I gave up on 111 after I phoned for dd aged 10 months, high temperature, floppy, being sick and not wanting to be held which was unusual. With those symptoms they took over 12 hours to call back.
By that time I'd seen the doctor and had antibiotics, but with a baby with those symptoms you would expect priority. They called back to say they would dispatch an ambulance-which then was cancelled as she'd been seen.

I once called them for my elderly mother because she had injured her ankle the previous day and insisted she wanted a doctor although she could walk. She was on Warfarin and I was aware of the risk of internal bleeding, but it didn't look swollen or bruised and I thought that if she had haemorrhaged seriously it would have been obvious much earlier. I'd already tried to get her to the local minor injuries unit but she was adamant that she couldn't get into the car. The 111 person said I had to get her to A&E immediately. I said I'd already tried and it was impossible, and that if that was really necessary we'd need an ambulance. After a bit of toing and froing during which we established that I'd already tried every possible option for taking her myself, they decided that maybe it wasn't so urgent after all and they'd get a doctor to phone. After the doctor phoned, he agreed completely with my views and was able to satisfy my mother that all she needed was to take a paracetamol and rest the ankle a bit.

Either they need to change the algorithms or train people much better, or both.

Ambulance wasn't allowed to leave as I had slightly raised BO

It's cheaper than proper medical care, that's why.

I don’t believe it is though, they cause so many unnecessary A&E visits and ambulance trips.

My sister works for 111. It is just people reading a question on a screen and pressing yes or no.

They have 4 or 5 levels of severity and have to give you the advice the algorithm tells them even if they know it's stupid.

The reason they flagged it as so urgent is because you called for a child. If you'd have phoned with the same issue for yourself they'd have booked you in with a GP straight away.

You have to consider the fact they get 100s of calls every day and so many people argue with what the algorithm says (as you did). If you're so sure you know how serious it is or isn't you could've just waited until your GP was open.

Refusing to get a child medical attention recommended by a professional is neglect, I guess, hence the SS comment.

IMO 111 is basically for when you're not sure whether you need to go to hospital or not. If you need a GP appointment you could've just told them you know you need a GP and just need to make an appointment. I did this on my Midwife's suggestion when I needed sickness tablets and didn't need to go through the whole rigmarole.

@Not111

Oh it's almost certainly costing the system money. I totally agree there.

However, it's cheaper as regards the individual service. The daft, short term, privatised system we have now is positively designed like that. Bloody stupid.

@KingaRoo im an A+E nurse. We do get clogged up because of the 111 recommendations. Luckily we have links to a drop in centre manned by GPs down the road - 9 times out of 10 the person will be redirected there. That works for us but it messes around the patient.

I should also say that the drop in centre is only manned 10-6 so is manned by locum GPs. So its expensive and GP staffing is variable depending on who picks up the shifts

Wow so they're just following an algorithm!

@Lovestonap if the algorithm worked out that my dd may die from and earache, then I think it seriously needs reviewing.

A few years ago I could call my out of hours for advice. Looks like things have changed a lot since then.

I know it is just an anecdote with no relevance to the overall picture, but when I was lying on the bed with a heartbeat of 30 and getting lower, DH rang 111.
After taking details they rang back to say our GP was not answering their special number (didn’t know they had one), they sent an ambulance which arrived within minutes and I was fitted with a pacemaker the next day.
As I am alive thanks to them, I look kindly on 111

I tend to find them quite unhelpful especially regarding children. When DD was 10 weeks she had awful nappies and then a rash (it was a sunday night). The dispatcher said I had to pick a symptom I was more concerned about or they couldn't talk to me. I pointed out I had no medical training and it was the combo I was worried about. All I needed was reassurance but we were sent to A&E to see a doctor who basically said she was fine and if she still had bad nappies after 3 days to seek advice. This weekend we called as DD woke up howling in the dead of night (now toddler) and seeming in pain when swallowing. The dispatcher was dismissive at best and declared she had a cold+teething with no advice or help at all. I took her to the GP the next day who confirmed hand foot and mouth. I'm getting to the point where I just wouldn't bother.

We have 111 in Scotland but it is definitely staffed by nurses - having done my mandatory training alongside a lot of them (life support, moving and handling etc etc) .

They have a band 7/8 to contact, call handlers are usually just band 2 level afaik but once you speak to someone they’re generally trained/registered nurses - they use the term ‘nurse’ which is legally protected in that sort of setting .

Never had a problem with them before - they even have a very good system on weekends where you can talk immediately to a psychiatric nurse now, even if you’ve never had a referral before .

That said we are far less likely to get A&E referrals up here as many places simply don’t have access overnight except via ambulance - too far to travel/too expensive for a taxi (£60 each way here) .

So it’s usually a case of referral to the out of hours team or minor injury unit instead . Both of which are staffed by local GPs and nurses .... means you’re sort of being triaged in person without needing to go to A&E and there’s a good chance you’ll be seen by someone who already knows you (whether nurse or doctor) . OOH doctors can send you onwards , but usually directly to a ward instead bypassing A&E altogether .

Have quite a few friends work in A&E and they do say they still get time wasters come in but they triage before anyone is admitted through to majors including NHS24 nurse referrals (apart from the obviously very ill!!) meaning a lot of that sort of patients are sent to OOH GP, local pharmacy or home instead of being seen by A&E staff .

You do though get people who know the system very well and know how to play to their advantage unfortunately, but that’s usually for individuals seeking morphine etc .

@tajobquery here there are also qualified nurses, doctors and paramedics too but you only get referred to them if the call handler doesn't get a definitive answer from the system

Sorry, here being England

I called them at midnight last week because my three year old had woken with a temperature of 41, was confused and upset and holding his ears. I just wanted to make a GP appointment for the morning (was a weekend). I had to go through the questions and then he refused to try and put his chin to his chest as he was upset and confused. The person said to me if I answered no it would be an ambulance trip to A&E, if I said yes it was a nurse call back within an hour. I said yes as it was obvious my child didn’t have meningitis and just had ear ache. The nurse then took 5 hours to call back rather than 1, 2 minutes on the phone to her and she had made the appointment.