111 and A&E

[Hotchocolate4]

Maybe I’m super naïve but after ringing 111 to try and get an out of hours GP appointment for a child, they tried to send an ambulance (CAT3).

I said please don’t send one i can get them to a walk in centre / a&e myself.

I was told by a receptionist that 111 is privatised and they get more money for sending people an ambulance or to A&E. No wonder so many times we have been sent to a&e when I have thought it’s over kill.

I was a bit taken aback as I always thought ringing 111 was sensible to make sure you are using the health service correctly but if they make more money for sending ambulances I almost feel like making my own judgement than calling 111 or being firmer with wanting an out of hours GP appointment.

Did everyone else know this? Have I been hiding under a rock?

Well I don't think they'd send an ambulance at all would they? They'd get the ambulance service to do it? But maybe it's a child so they have to? And they always say go to a&e because there's often nowhere else to send you to. It doesn't mean you'll get seen any sooner.

Gawd knows why they'd get more money to direct someone there. That makes little sense.

This makes no sense. Who is paying 111 more money to request ambulances or encourage A+E attendance? The NHS certainly isn't, all initiatives are to reduce unnecessary ambulance call outs and attendances in A+E. The difficulty is that the all call handlers are following an incredibly risk averse algorithm on their screen that once you have said a certain symptom or 'buzzword' for want of a better phrase, they have to advise A+E- the threshold is even lower for children as they can deteriorate so quickly and noone can see them over the phone.

In our area we I have 3 walk in centres and at least one does out of hours GP appointments which is what I wanted.

111 definitely can send ambulances which is why I was confused the receptionist said it’s privatised. Maybe they are wrong and it’s not?

It sounds really odd they said that. All calls are recorded and that person will almost certainly lose their job if it comes out she told you that. Whether it's true or not tbh.

I rang 111 the other week for my 2 year old, as there were no GP appts and the pharmacist wouldn’t look at her.

They said they would get someone to call me back within an hour and if someone wasn’t free, they would sent an ambulance to assess. So i got the impression it was because they couldn’t get someone to speak to me to book me into a&e or out of hours. Seems silly

111 is NHS run. They belong to a trust and share a lot of the same buildings as 999 call handlers.
it is not privatised, at least in the SE

Surely if there was money changing hands based on outcomes of the calls, they’d be paid for not sending out ambulances? They’d be paid for sending people to a pharmacy and thus saving the NHS money by avoiding the expense of an unnecessary A&E visit?

111 is “privatised” in the sense that it’s a service “bought” by the local health authority and is often run by a private company. Round here ours is run by Practice Plus; in the next county they are actually run by the local ambulance service from a separate call centre in a shared building.

111 can “send” ambulances in the sense that if the indication is that an ambulance needs to go then you are triaged in the same way as you would be if you’d dialled 999. 999 is a terror for telling people it’s safer to wait for an ambulance, even if the ambulance is half an hour away and the hospital only 5 mins away.

Who told you they get paid more for sending ambulances? Someone from 111? 111 are pretty risk-averse but my understanding is that they don’t get paid-per-call - they get a lump of funding for covering a particular area and that’s that. Certainly 999 don’t welcome 111 ambulance calls.

111 is run by different organisations depending on where you are in the UK. In my area it's the Ambulance Service. Either way though that sounds like absolute bollocks from the receptionist. Exactly who is giving them money for a and e trips and ambulances and for what purpose?! It makes no sense.

It is bollocks that they’ll be paid extra for an ambulance call out. That is the exact thing they are incentivised to try and avoid. 111 as a service can be contracted out but they have to put in place measures to avoid ambulance call outs if possible. Eg will often pass to a clinician to triage or check. Now if something is flagging as severe you’d expect 111 operatives to effectively convert a call into an emergency one. Sometimes people call 111 instead of 999 or minimise the severity.

It is easy to scoff at 111 sending people to a&e unnecessarily but they have to take quite a low risk threshold as the call handlers follow a specific script and they don’t have the patient in front of them. There will be something you said in the triage process that escalated the risk.

I would also say I have had two occasions when 111 missed the severity of illness in my child as they didn’t fit neatly into the algorithm. One where my 1 year old had broken a leg and they told me I could self care (I had phoned to see which hospital I should go to given some don’t see under 2s). A nurse rang me back a few hours later once I was already in A&E checking that I’d ignored the handler and gone to hospital.

The second time, I knew my child had a specific condition and called at around 7pm. It didn’t fit the algorithm and they basically just ignored me with no clinical call back as the handlers just hadn’t got the severity at all. My child was admitted the next morning to hospital.