Has anyone else experienced being pushed backwards and forwards between 111 and a GP practice like some bizarre game of hot potato?

[HotPotatoGame]

I'm just wondering how prevalent this is or whether it is a purely local issue to us. ..

My daughter was sent home from school at lunchtime with an asthma flare and having followed her asthma action plan I realized that we needed the same day GP appointment. I rang the GP practice and after 30 minutes on hold I spoke to a receptionist and explained the issue and was told that they had no same day appointments and that I needed to ring 111.

I called 111 and after some more time on hold I spoke to the initial assessor who then arranged a clinician call. The clinician called very promptly but having run through the same set of screening questions they told me that my daughter needed to see a GP face to face the same day and that I needed to call my GP practice back.

I called the GP practice back and after another 30 minutes queuing I spoke to a receptionist and explained that 111 had asked me to tell her that they wanted my daughter to be seen by a GP that afternoon. The receptionist was refusing and saying that this wasn't possible as they had no spaces and that I needed to call 111 again. I put my foot down at that point because it was clearly not acceptable to just be push backwards and forwards between services. She agreed (very reluctantly) to send a message to the duty doctor who thankfully did agree to see my daughter and having examined her prescribed steroids.

Anyway after posting about it in a local Facebook group I have discovered that this has happened to a lot of other people locally using the same surgery or other local surgeries. And I guess I just wondered if it is very much a local geographic issue or if it is much broader than that?

It just felt really hard to be in this strange game of hot potato between services with no one taking responsibility.

I didn't feel that the issue was bad enough to need a trip to A and E but I equally knew that my daughter was likely to need steroids. I can see why A and E ends up overcrowded if people are just not able to access GP level care

(please note I am not a new poster but I have named changed for obvious reasons)

Dd had tonsillitis again. Needed antibiotics the first time. Really poorly. Bounced between trying to see GP, 111, sent to pharmacist who agreed tonsillitis but can't prescribe.. Back to 111. Suggested GP.. No appointments as previous call.... Back to 111. Got appointment at out of hours. Then queues at pharmacy.. All the while dragging an infectious poorly dd along.
13 hours before I got her a prescription done from initial morning call.. Odd bloody system.

I used to work for 111 and yes, this does happen. Where I worked 111 could only get you seen by a GP through the out of hours service. If someone needed to be seen there was little 111 could do on week days before 6pm. It was literally just advice.

GP surgeries should know this and not try and fob people off with 111 when they clearly need an appointment but it did happen. Some of our more strident nurses would call the GP practice themselves on the patient's behalf. They weren't supposed to as it wasn't proper process but they stepped in if they knew someone should be seen.

Written complaint to practice manager. Not a phone call.
I think in this instance the receptionist was overstepping their responsibility. Once you said thst 111 advised same day appt that should have gone straight to duty doctor with no argument. Indeed if you have an asthma plan, that should be displayed on the home screen and the receptionist should have messaged the duty gp at that point. So the receptionist dropped the ball twice.
Ask the practice manager what the reception triage training says about Asthma plans and 111 instructions.
The receptionist needs retraining.

Yeah ive had this you need to wait until the gp surgery has closed and then 111 can make you a same day out of of hours gp appointment

Thanks yes I've done an email to the practice manager setting out my concerns too

Not least because when the receptionist rang me back to say the duty doctor would see my daughter she also then said to me " but this can't happen again!" Which I thought was utterly baffling given it was a situation created between the practice and 111 and all I was trying to do was get medical help for my daughter . I did say to her that I felt that this was a conversation they needed to pick up with the 111 service and not with me!

I've been parenting children with asthma for 15 years now so I am pretty experienced in gauging when they need to see a doctor and historically doctors were always brilliant and if I said it was an asthma flare in a child they would always be seen

Wow! Who put her in charge of the surgery?
I would report that to the practice manager too. This attitude and behaviour is dangerous because this receptionist is massively overestimating her knowledge and rrsponsibility. If she isn't managed something will go wrong, perhaps badly.

Yeah there have been a couple of occasions where I’ve needed to call 111 about my young DDs. There’s no point calling them at, say, 17:30 because they’ll say “see your GP today” even though this is obviously impossible because they close in 30 mins.

This happened with my dad before Christmas. He was severely anaemic, he’s housebound following a fall in September. GP refused home visit, 111 said GP responsibility … back abs forth. I gave up and called 999… they came out and admitted him. He needed 5 bags of blood and then an iron infusion. He was in for a week over Christmas. It’s shocking treatment by GP’s

I agree I found it really concerning, I've highlighted it in my email to the practice manager.

It just seems like a very odd system where by two o'clock in the afternoon there is a gap when you are not going to be able to see a doctor until the evening . We have terrible issues with wait times our local A and E and I can see why if there is no way to get GP level care

That was awful, but in OP's case the receptionist didn't even tell the duty GP. I hope the GP was subsequently informed of OP's complaint by the PM.

I can't work out whether it's the GP surgery or the 111 service that is at fault it feels like a game of hot potato between the two services at the moment

I don't recall having these issues in previous years - it feels like a fairly recent shift?

Yes to be clear it's the practice management element that's worrying me the the duty doctor was brilliant really kind and thorough and and gave us very clear instructions on what to do if symptoms got worse and made sure we had a review scheduled with the asthma nurse as well. She even called me the next day just to check in on my daughter. In fact all our local doctors are absolutely fabulous in my experience it's the receptionists and practice management element and the relationship with 111 that is worrying me because I can see that people less assertive than me may end up missing out on badly needed care

So unfortunately the gp was full.
there are only so many ‘extras’ they can add and see before it is dangerous.

after a complaint about ‘rushing’ a patient. I no longer will add extras. Collecting my children on time at nursery and not having them standing crying is now more important.

When full - we now say 111, UTC or if you feel it is an emergency which can’t wait to tomorrow (which gp should never be) then A&E.
Please complain to your MP about shit funding.

Simply adding extras just makes patients think the receptionist is lying and we have all these free appts for patients.

I feel sorry for patients but I will no longer risk my registration, my children or my livelihood.

111 - they absolutely know they can’t tell patients to insist on the gp seeing them. They absolutely do for a quiet easy phone call.

From what you say, 111 followed the correct protocol but the receptionist did not. she took it upon herself to

• make a clinical judgement she was not qualified to make
• did not inform the appropriate clinician
• did not follow the instructions of the clinician on the 111 call.

You should also ask the PM if there is an asthma alert on the your DD's home screen. The receptionist should have seen this as soon as she pulled up your dd's record when you phoned.

I had no issue with going to 111 at all I fully understand that the GP has a limit to how many people they can see my issue is being passed backwards and forwards like a hot potato with no service having to take any responsibility. .. .

All I want is sign posting to the right option that is available. My daughter's asthma plan made it clear that she needed to be seen the same day and I was pretty sure she was going to need to steroids but equally this did not feel like a situation that required A&E .

I also don't understand why if they are not going to take any more patients there isn't a message when you first call so that you don't spend 30 minutes on hold only to be told that the GP can't see anyone that's 30 minutes I could have spent investigating other options

I definitely don't feel you should have to stay late or risk the quality of care that you can provide I'm not asking that of individual GP's -just for the process to be transparent and logical. It's the game of hot potato that I objected to

I completely understand, but I think the duty doctor is the best person to advise the patient to go to UTC/A&E/walk in, or whatever is available in the area. They can phone ahead if necessary.
In my area 111 route through GP during surgery hours, but other services outside that. It varies. Patients shouldn't be passed back and forth.
When I was working, one of the GPs was duty doctor for the day, or it was shared am/pm. It takes seconds to ping a message through, link to the record and get advice. No excuse for the receptionist not doing that.
I don't know how single handed GP surgeries manage. There weren't any among the practices I covered.

But why was the system SO much better before Covid?
It now virtually impossible to get an appointment, yet if you do go in person, the waiting room is empty.

To me I think that if 111 have identified that a patient needs to see a doctor face-to-face and quite urgently that they should take responsibility for ensuring that they signpost to a service that they know can see that patient. In particular when the patient is a child or otherwise vulnerable service user who can't advocate for themselves.

I feel that if you ring up a service like 111 that they ought to carry that responsibility and not be able to just pass the buck backwards and forwards.

It just struck me as hugely dangerous.

Probably because they have no staff! Gp’s are statistically seeing more pts now than before COVID, with less of them. Our clinics are rammed day after day. I’m a PN and no appointments for a month.
Don’t blame the driver if the bus is full.
I’m following several colleagues of late and am out this year and cannot wait.
Sorry for your experience though OP. The whole thing is shit. And make sure your DD is on a MART regime if she already isn’t.

Yeah I fully appreciate there is a whole different conversation about how full the system is and I am well aware that GPS and all staff in the medical system horribly over stretched. It's just really frustrating to just be passed backwards and forwards in a nonsensical loop.

@DemonsandMosquitoes yes she's had symbicort for a year now, it's been a lot better year for her actually this has been our first trip to the GP all winter

That's frustrating OP. It was a few years ago now, but I once called 111 with a wheezy toddler DC because the GP surgery had said no same-day appointments left. 111 called my GP surgery themselves and insisted we were seen face-to-face that day (which we were).