To think NHS 111 is a fucking joke?

[NillyNolly]

I have had the misfortune of experiencing the new NHS 111 service three times in the last week. One of my DC has a compromised immune system so often need out of hours appointments.

Before the 111 service I could call our local out of hours service who would answer straight away, listen to a brief description of symptoms, then make a doctors appointment or get a nurse to call us back. Simple.

With 111 I have waited an average of 20 mins for someone to pick up each time, had to go through all mine and my DS's details about 3 times, then had to answer a series of questions which takes a further 10 minutes ("is he breathing?" ..... Ummm, do you not think I would have perhaps called an ambulance by now if he wasn't....?)

I am so angry and frustrated with this new phone line!!! !!!!

[jaywall]

A little 101 about 111

Previously with the OOH set up what you had was every area of the country was covered by an OOH service + NHS Direct. Some of these OOH services were small, some were large and they ALL did things differently. You as a user could call either NHSD or your local OOH service or go direct to your hospital.

Also, many people had no idea an OOH service existed let alone the phone number for it. And i happen to know that is the case for a large number of people in this country, unless you had needed to know you probably didn't.

So 111 was dreamt up, a national number that can be utilised in so many dreamy ways. It will free up 999 operators, it can be mapped anywhere and in any way. And it fits right in with drop in centres, walk in centres, the expanding emergency dental requirements and even all the current OOH services as it can link in with any IT system able to communicate via existing standards for information interchange.
It also means every health service in the country can make themselves available, or unavailable in just one place that everyone with an interest can access. They can list what they are equipped to deal with and update this and have it known by anyone looking for that service immediately.

And it can provide a better service for less cost...it really actually can. Before, every area of the country had their own OOH + NHSD, all of them needing enough staff to fulfill required services. Whereas with 111 your initial call can be answered by regional centres or national centres, in fact anywhere. Where an operator can take your call and follow an algorithm which has been designed by a large group of NHS clinicians, and pass your case to the service that best suits your requirements wherever it is in the country. In many cases they can even book you an appointment right there and then anywhere in the country, with details of everything that happened passed automatically on to your GP for their records or action.

It will be a great asset for all of us once the teething problems are dealt with and experience in the systems is built up.

[rubytubeytubes]

Unfortunately jaywalk that isn't actually happening though is it? Lots of promises there but when will that happen?

In my area it failed in the first two hours. Our local OOH service is very good and highly rated because it is staffed by well qualified local clinicians Who can advise on local services/ pharmacies/shops to buy meds from.

Lots of nurses left the ooh as they didnt want to work for 111 only to be asked to come back and help in that two hour period, they gave up their own time to ensure services for patients continued.

I think the system will continue to fail and in a few years local OOH services will be brought back!

[jojo2013]

Can clearly say I had to phone 111 they were courteous and passed me straight onto a practioner who went through my partners symptoms, they were concerned they wanted me to talk to an ooh doctor, now thats where the problem. Was......6 hours later a doctor called only to say could you pop into the surgery 4 hours later, now fully exhausted I saw him to be told your own GP knows more about your partner, can you see him SHAMBLES!!!!
What is it with this uncaring government?

[jaywall]

Why do you think they will continue to fail ?
Where you around when NHSDirect started to take calls? that didn't go well at first but after sorting the teething problems and getting the right staffing it was a resounding success.

This is NHSDirect as it would have been if invented in 2013. I fully agree its not good right now, but the scope of what it is able to do, with the same resources is a huge improvement.

I don't want to be disingenuous but seriously why should'nt we take advantage of new technologies? why shouldn't we invest our taxes in moving with the times and utilising the things that other industries take for granted ?

The local OOH services have for the most part not gone anywhere, all the doctors and nurses are still employed doing mostly the same thing, the only thing thats changed is the front end, the services are all still there.

[jojo2013]

The ohd service is a joke, at least the 111 device tries to filter out and prioritise what is more urgent and what can wait, 99% of the time the ohd will not come to your house, my partner has heart problems and is always told to drive to the local hospital 15 miles away....FYI I don't drive and have 3 kids at home.

[Hawkmoth]

Same resources? Unlikely. Using a non clinical algorithm makes it more risk averse than clinical triage models used previously, therefore more people will be referred to see doctors, attend A&E or 999. Which, of course, is safer, but it will cost the health economy more.

[NillyNolly]

I had to call again yesterday (same story) then again today. Today was slightly better, I got through quickly to a guy who didn't run through the script (hope he doesn't lose his job), simply asked what DS was doing (watching tv) and how he seemed. He gave us a doctors appointment and that was that.

Perhaps they should have a common sense/aptitude test as a prerequisite for the job?

[Wheresmycaffeinedrip]

Well I just had to use this service as dd1s infection is spreading. The lady was very nice but I did have to go through all "the safety questions" despite already having answered yes to is she conscious and breathing . It does seem a bit like what you say doesn't matter as they have to ask set questions and don't deviate whatever u say.

Perfectly pleasant person manning phone but alot of time wated on irrelevant stuff (irrelevant in this case)

[Fairylea]

I suspect a lot of people will go straight to A and E rather than take the risk of ringing 111 and not getting any help or having a long wait, particularly parents who are worried it might be something serious but aren't sure.

A and e will suffer massive floods of people turning up for all sorts.

I doubt overall 111 will save any money when you look at it like that.

And of course waiting times in a and e will become longer as a result.

[Kiriwawa]

Jaywall: I haven't read your very long posts in a great deal of detail but this: "Before, every area of the country had their own OOH + NHSD, all of them needing enough staff to fulfill required services. Whereas with 111 your initial call can be answered by regional centres or national centres, in fact anywhere."

is factually incorrect.

NHSD was a national service, staffed nationally, meaning that if a service fell over or was experiencing excess demand, calls could be diverted to other call centres (or even nurses working from home).

111 has been locally commissioned so it depends what back up the local provider (in many cases private) has in place.

111 is cheaper than NHSD because it's being staffed by monkeys rather than nurses. While I agree that it's great that 111 can make direct referrals to OOH services, there's no reason that couldn't have been done with NHSD. The only reason the government has got rid of NHSD is because it is expensive - this way, the cost is pushed out of a central government overhead and down to regional healthcare budgets. Some commissioners have opted to have bolt ons to the basic service, some haven't, meaning that the functionality of 111 will differ between areas of England.

The ambulance services that already complain about NHSD advising people to call an ambulance for minor ailments (on the basis that they err on the side of caution) aren't going to know what's hit them over the next few months. This is a poorly thought through cost-saving exercise, however it's dressed up.

[BlueFishWonder]

I had to call 111 last night as was concerned DS (2 years) was going down with an ear infection, temperature, complaining of ear hurting, very upset etc. what irritated me more than anything was the fact the call centre person could not understand me and I could not decipher what she was saying at all. the whole thing took nearly an hour, I was then promised someone would ring back within 6 hours. I am all for equality and diversity but do think people taking these calls should be able to understand english and be unstandable on the phone.
the series of questions was ridiculous and in no way related to DS's ailment! Luckily Ds improved over the course of the evening and night - this was especially good as no-one actually phoned us back! DS ok today on calpol and quiet rest and I will take him to my own Dr tomorrow. If he had been any worse after my experience I would have bypassed the 111 service and taken him to a&e, which is the absolute thing they are trying to avoid.
Got to say i wasn't impressed at all.

[MissBetseyTrotwood]

Got through fine, on assessment the call handler said I needed to speak to a GP re. DS2's symptoms.

And... no call back.

Their system went down and they said they would fax (arf, last time I heard that verb was in about 1992) our details over to the OOS. Took him to the GP walk in in the end, which was what I had been trying not to do.

I realise they have to ask the basic safety questions etc - it's all part of the procedure and that's OK. But the basic systems that are fundamental to the safety and integrity of the service are faulty here and I don't know why they've still gone 'live' with these major issues.

[Fudgemallowdelight]

I just looked on the NHS Direct site and it says (as an example) that if a child under 6 months has breathing problems to ring 111. Bit worrying!

www.nhsdirect.nhs.uk/CheckSymptoms/SATs/BreathingProblems.aspx

[Kiriwawa]

MissBetsy - they had no choice but to go live as of 1st April. Many areas didn't award contracts until the very end of last year which is not long enough to get adequate systems in place.

Totally agree that faxing is insane but some GP surgeries and OOH providers don't have any other facility for passing on patient notes!

[Mumsyblouse]

Jaywall clearly you work for one of the large IT consultancies that has benefitted so much from the 111 design and implementation, but your optimism about the NHS being able to utilize these new technologies is completely misplaced- what about the new online healthcare system that has had to be abandoned?

My husband also works in IT in security and his opinion is that large interconnected networks like this always fail, and are massively insecure (as lots and lots of people can access them), plus all local knowledge is lost (e.g. which chemists are open, which drs wil come for a home visit). Now you have a centralized service for non-emergency calls where, because of the IT failure over health records, you can't even see someone's medical history! And instead of immediately passing this person on to an OOH doctor who can make a quick assessment, they are assessed by non-medical staff using a script...

The confidence of IT professionals despite the overwhelmining evidence of their inability to hold together these 'joined up services' is quite incredible and has cost us a lot of money- witness the faxing of patient notes as a method of communication in 2013!

[Thurlow]

I hate it. I called about a 8mo with diarrhea, they told me to go to A&E, A&E were very when we got there and the doctor made a few comments along the lines of "is this your first child?". I wouldn't have gone if they hadn't told me to! All I wanted was to talk to a doctor who could explain the signs of dehydration, reassure me that baby was OK to sleep all night, that sort of thing. But we've not got anything around here than the 111 system.

[EldritchCleavage]

I think losing OOH is mad.

We had to speak to NHS111. We got through straight away, the person answering was nice but it is disconcerting to have a medical issue, especially with a small baby, and have to talk to an untrained person going through a checklist, most of which you both know is completely irrelevant (for which she apologised). We were referred to an OOH GP who was great- helpful and decisive. He told us to go to our local Paediatric A & E.

But actually, DD needed a quick evaluation and a one-off steroid. The kind of thing that a locum/OOH GP doing a home visit or in a local clinic should be able to deal with, and did once deal with.

While I'm very grateful to our fabulous hospital, it seems mad that highly trained and over-stretched hospital paeds were dealing with her. We've lost a whole tier of GP service. Surely bunging everything into A & E is costing far more than having a proper out of hours service?

And a paramedic we met told us to bypass 111 and ring 999 since that's where 111 refers all the calls anyway. Bizarre.

[knightynight]

My only experience so far of 111 was poor. My ds of 5yrs had a temperature for 2 days then on 3rd day could not bear weight at all on his legs. Luckily I was not exceptionally worried as I had heard of a friend's son who had the same thing, but still I wanted to know what to do and if to go to the doctors or not.

I wish I hadn't bothered. The receptionist arranged for a call back. This came quite quickly, the person went through the checklist (fine), listened to the symptoms I gave (fine) and then told me she could not help as she could not give medical advice!!! So I said, 'should I just take him to the doctors then?' and she said yes.

Waste of my time, their time and all of our money!

So I went to the doctors (sit and wait at least an hour of course) which I should have done at first I guess.

You are right, It IS a joke. NHS direct was great. Why change it?

[jaywall]

Kiriwawa


It is actually perfectly correct, every area had NHSD as well as their own OOH service. Duplicating services in many ways.

These OOH services are either all still there maybe taking calls or just taking cases referred to them from 111 or had their contracts taken up by someone else.

111 has been implemented where it uses an algorithm that can pass your call to a nurse or doctor or recommend and ambulance or wait until your GP is avaiable. It is not limited and can

Almost everything you are arguing about is possible and already a part of 111, i don't mean to be condescending but you don't have the whole picture. NHSD have always been able to refer to OOH services, they always have linked together with OOH services but now they have many more options.

111 is not staffed by monkeys, the first layer that a patient will make contact with is not medically trained as was OFTEN the case previously, now however they have an algorithm which can identify how best to then pass the case, to a nurse or doctor etc. All as it was before but better managed.

There are obviously problems right now, i hope they get fixed quickly because the service will be better than before.

[jaywall]

Mummsyblouse

You clearly have no idea what you are talking about. A clinician can see clinical data about patients they talk to, this has been working and utilised for ages.
Im not getting into details about this as it is a whole different kettle of fish but the services you are talking about are there now.

Your husband is also mistaken, there happens to be a private network for the NHS from the top to the tip of the country, maintained by one provider.

Your point on local knowledge is also incorrect. Firstly it wasn't there with NHSD and only may have been there with the OOH providers for the local area. Many OOH providers had already outsourced or centralised there call handling out of area.
Now with 111 there is a central repository of availability and services provided for every service in the country that they individual services update themselves in real time. Exactly the data you are talking about. It can and does automatically give the information on a case by case basis based on area or postcode or other demographic.

Anyone utilising a 111 call can at any time pass to a Dr or Nurse or take other appropriate action, within clinical guidelines.

Your point about Faxing is interesting, and im glad you bring it up. It is a hangover from the older services in use before more modern IT solutions. I think you will agree that we should more to more modern solutions?

incidentally faxing is still used widely in OOH services to get data to some GP's surgeries. The services are available to have all this done automatically but not every GP chooses to spend their money on these. Most, however do.



What is very clear is it is not working properly yet, why, i don't know why i only know what the system can and does do. And that in itself is a vast improvement for the ability to provide and give access to health resources.

Im done now. Knock the system as much as you like but try to be accurate.

[Evenstar]

I haven't been well enough to post my experience till today and I am sorry this is very long, but I want people to know just how bad this service is and I intend to write to my MP and PALS.

I have had 2 bad experiences with 111, the first one was 2 weeks ago when I was suffering from severe lower back pain to the point of being bedridden, unable to walk properly and hardly able to reach the bathroom. I rang 111 as it was Sunday morning and was told it might be up to 12 hours until the doctor could call me back. After explaining to the operator how bad things were she wrote urgent on the paperwork and said she would try and get the doctor to call sooner to get me some pain relief. The doctor did ring back in around an hour and agreed to put a prescription at the hospital where our local out of hours service is based. My partner went to pick it up and had to go back again after he had been to the pharmacy as the prescription was incorrectly filled out.

On Sunday night I ended up stuck on the floor and after trying for half an hour to move we had to call 999, I was given gas and air and lifted with a cushion and taken to A & E for more checks on the paramedic's advice. Once there I was left with no further pain relief, and after being checked over and given more tablets was given the option of leaving at 3.15 am in the morning or moving to the observation ward. The nurse had already refused to assist me in any way in getting back into bed after my examination and told me I would be better off at home as there "won't be anyone to help you on the ward". As the paramedics had had to help me to the toilet before I left home I felt I had no option other than to wake my partner and get him to come and fetch me, they fetched a wheelchair as I couldn't walk that far, so I don't feel the taxi they suggested as another option would have been appropriate.

This was bad enough but on Easter Sunday I had to ring 111 again, I have been waiting since February for an "urgent" appointment at the hospital to have a tooth removed under general anaesthetic/sedation as I have tri-geminal neuralgia, on Easter morning I woke up in terrible pain with neuralgia and toothache and a face like a hamster I rang the out of hours dental emergency line and was switched through to 111, the first person I spoke to was a young man who told me he had no medical experience/training whatsoever and had to ask me the spellings of all the medical terms. I was rung back shortly afterwards by a nurse, who told me that I needed be dealt with by the doctor for my neuralgia and the dental team for my toothache/abcess. She said she would arrange for the doctor to call me back and that I would have to ring the dental emergency service for the neighbouring county as I was too near the county border to be treated by the one in my own county.

I tried ringing that number, but there was no reply and the number just wouldn't connect. I was then contacted by a receptionist at the out of hours service to check my number before the doctor rang me. The doctor rang just after this and said she couldn't deal with me at all as I was a dental patient and the neuralgia was due to the dental issue, despite the fact I have had it for over 2 years, she also told me that she had 20 patients still waiting for a call back from the day before.

I tried again to contact the dental emergency line for my own county and they were able to get me an appointment at a town 20 miles away "as a favour" DP had gone out by this time so I had to drive myself. Whilst I was waiting to be seen a lady arrived with a young child she was sobbing and in terrible pain, as she had got lost and missed her appointment and had also driven miles.

As I predicted the only thing the dentist could do for me was give me antibiotics and painkillers as nobody can touch the tooth due to the neuralgia, the doctor had refused to put out a prescription as they are not allowed to do that anymore "as somebody wasn't diagnosed with oral cancer due to not being seen by a dentist".

I tried 4 different pharmacies on the way home, all were closed and the final one had a notice in the window directing people to an area I don't know well, I couldn't find the one that was open, my eye was closing due to the neuralgia so I went home. DP went out to get my prescription and came back as there was an hour's wait. In a very heavily populated region it was the only pharmacy open within a 10 mile area. When he went back he had to wait another 10 minutes, the pharmacy was quoting an hour and a half wait to anyone who was already there and turning away people on the phone pleading for them to do prescriptions, including someone with a sick three year old who needed antibiotics, as they were closing.

I am in utter despair at the plight I have found myself in twice due to this shoddy service, and I worry for people who have nobody able to help them or offer transport to collect prescriptions/take them home etc. I feel utterly let down.

[StayAwayFromTheEdge]

Jaywall - you said "A clinician can see clinical data about patients they talk to, this has been working and utilised for ages."

I assume you are talking about Summary Care Records here - not a full history? SCR are not looked on favourably in our area, in fact if you look at the medication list it can be quite dangerous as it doesn't say if Meds have been discontinued, just that they have been prescribed. The availability of SCR varies from one GP practice to another - my GP hasn't implemented it yet.

[Mumsyblouse]

Yes that's right, there's a central repository of information, which the people on the phones can't know about as they themselves are not local, have you ever tried to phone Yellow pages or one of those numbers and ask them about a restaurant down a well-known road- they can't find it either, or it has closed down, or the opening hours have changed. All this dynamic local knowledge is lost, although I do agree with you thatas the OOH was outsourced, some of this was lost anyway although when I used the OOH service for myself, it was amazing, I spoke with a local GP and an ambulance was with me within minutes.

There is no central full patient record system, why pretend there is? It is well-known that the whole project collapsed. This affected a member of my family recently when not only their records were lost, but the referral letters for their surgery, this took over a year to sort out by which time we had paid privately to see a consultant in a different location out of sheer desperation to stop their pain (after numerous calls to PALS/hospital/GP). The NHS has an incredibly inefficient patient records system, ok if you go to your local GP's surgery, but if you work in one county and live in another, the entire thing collapses inwards. You are completely wrong that any health professional who needs it has your information, I can assure you that's why they need to take a medical history from scratch (again and again and again), they rarely have the full records and even if they do, they are often in an incomprehensible unstandardised form! I know this as I have had to search these records for a certain type of data from my job, and it was on the backs of envelopes, falling out of files, and never properly recorded electronically.

My husband comes from a supposedly more backward country, but if he has a blood test in the local surgery or a throat swab, the results come through in real-time 30 min later (or however long the test takes to do). Here you have to wait two days for them to ring you and you are never given a print-out of the information; it is all terribly terribly slow and the IT infrastructure is to blame.

[creamteas]

they have an algorithm which can identify how best to then pass the case

Except of course, that is part of the problem. Not only do you have to answer lots of questions that are irrelevant, quite often what you do want to say about symptoms do not fit into their decision tree. Bodies are complex, and symptoms can present differently in different people.

The response I have got twice is 'I don't have an option for that'.

[montage]

"NHSDirect: is he with you?
Me: no, he's at school
NHS: is he breathing?" [buconfused]

I would have been v tempted to say "I hope so!" Captainbarnacle but I can see any attempts at levity would not fit in the script!