111 failed to diagnose

[Shedidnt]

www.mirror.co.uk/news/uk-news/calls-nhs-111-helpline-probe-21216411?fbclid=IwAR3SMrfs8ptX0YbrlJozTL_PyeRzd2f6ijkqZsg_7P3EFkEi3F3Psbg2aAg

Am I correct in thinking that the warnings we are all given about not going to A&E needlessly is the cause of these deaths, and we're dealing with Joe Soaps and their questionnaires on 111 rather than trusting our own judgment?

As I have said before on these types of threads, not every town has a walk in centre or minor injuries unit. Indeed not every town has an A&E.

Our nearest walk-in & A&E are over 10 miles away. Out of hours the drive isn't too bad, but in the rush hour it could easily take an hour. If you haven't got someone who can drive you, a taxi is £28 each way.

I used to work with Junior Doctors.
Out of a group of 25 in one particular session not one was planning on becoming a GP, too much hassle for not enough money and not as interesting as specialising apparently. Also seen as not very glamorous
If this was typical, and I have no reason to think it wasn’t, then it’s very worrying for the future of our GP service

Maybe they were unusual then
As part of my current job I often have to brief people moving from overseas on how to access The NHS and most of them can’t get their head around having to go via a GP for everything, especially if they are going Private

Yes I entirely agree the GPs shouldn't be gatekeepers that system is very flawed.

So many great comments on here.
I agree that GPs should have free training and debts written off to encourage more into the role.

GPs have an interesting role. Although they are sometimes the gatekeepers to a referral, it's their job to do all of the initial donkey work like trialling meds, exercises, injections before the referral is accepted as the consultants do not want that donkey work slow part of the process. GPs do not refer everyone, perhaps 2 in 10 seen where I am - which means there job is so very important as a specialist in generalism.

Those OOH GPs you see are usually the same ones who are in a GP surgery later that week. There simply are not enough GPs to go around so advance nurse practitioners are being used instead.

Big love yo those working so hard this this challenging environment.

If anyone is interested... many GP practices provide extended hours cover for patients and the government has just reduced that funding, too. It's only going to get harder to be seen by a GP.

I have never had a problem with them thank god
Last year my son had a really nasty cough and cold and he started breathing funny in the night i spoke to 111 who said it sounded like a nasty cough and cold but that they would get the doctor to phone back.
After an hour he seemed to settle and i was getting ready to go to bed and the doctor phoned
i explained my sons symptoms and he decided to send out an ambulance
That night my son was admitted to intensive care with aspirated Pneumonia and the hospital told us they were really worried about him
He was in hospital for over a week
If i had not have called 111 that night i don't think i would still have my son

Used 111 just yesterday for DD they advised she could not wait for GP and should be seen within 4 hours. An appointment was arranged she was xrayed and diagnosed by urgent care (walk in). Today we received a call from the Consultants secretary for a further appointment and xray this week. Cant fault the speed with which DD has been seen and processed through the system.

I believe OP has a condition called givemeattentionitis

My sibling is an F1 and says it's about 50/50 between GPs and other specialisms. GP is still seen as the cushier option, which I truly cannot understand (my bil is a GP and gets worked to death. So stressful). I suppose it's the nicer hours, no night shifts, fewer weekends and evenings, easier to go part time etc.

I can imagine that is a royal PITA to manage!

I think it is one of the draws of GP as an option though and I suppose nobody wants to put anyone off GP as an option. It is a shame that it is seen as the cushy option as I think then people choose it for that reason alone.

My dad is fairly senior in a big hospital trust and he mentioned the idea of lay people doing a different degree to medicine and being trained as GPs! It was just a comment in passing though and he is not a GP.

@FeckOffGraham That already exists to a certain extent in the form of Physicians Associates. A newish role to the NHS with lots of bits still in development.

Oh right! He mentioned it a few years ago, so maybe that is what he meant. Should give him more credit really, but where's the fun in that ?

I think they take graduates from other health sciences backgrounds onto a ?25 month post graduate diploma course which teaches them how to examine, diagnose and treat patients. The last I heard the discussion about prescribing was still In progress but I’m sure it will happen, if not already as paramedics and nurses and other AHPs, can do courses to prescribe.

The other route is for current HCP’s such as physios, OT’s, Nurses, paramedics, etc to become Advanced Clinical Practitioners by doing a three year masters and professional development program, which is a very big focus of a lot of NHS trusts currently. Once qualified and competent these clinicians will work on the Middle Grade doctors rota, rather than on the nursing/physio etc rota. They’re also highly sought after in primary care.

Honestly... all these new roles are fab, but.... a lot of them end up deferring for an experienced GP opinion so takes double the time. There are some fabulous ACPs but it takes years to build experience and knowledge. It is a tough job, I would not want it. But so is being any type of clinician- fair play to them.

Not all ACP’s are in GP land. And one of the functions of ACP role in the hospital is providing support and guidance to junior doctors as a permanent member of the medical rota.

There are sorts of innovative roles but trusts cannot simply reduce the number of qualified doctors by employing ACPs. There are very specific contractual requirements for hospitals about the skills mix of doctors and they are measured against the proportion of consultants compared to England averages.
ACPs are sometimes very good....but they are not doctors and do not have the same level of underpinning knowledge. Most are employed in specific and specialist roles.

Yeah, I wasn’t saying they’re a replacement for Doctors, just responding to the PP who said her dad had mentioned something about a role to bridge the gap, which I explained already exists.

I don’t know what the answer is while the NHS is in the state it is. I have worked in A&E as a staff nurse, within the 111 service as a clinical advisor and now currently in the GP OOH/Urgent care based in an ED seeing streamed patients and shift leading.

I’ve seen it from all angles and I’m exhausted and demoralised and desperately trying to come up with another path for myself that doesn’t have such a personal toll on my stress and general well being.

Yabvvvvu!!!
As an ex 111 call handler I personally feel the system is very good. It is not flawless but it has saved thousands of lives. If you want a system where a medic answers the phone every time then you are damned well going to have to pay for it.
The pathways system on which 111 operates was designed and put together by medics and is extensively tested and updated frequently.

111 is NOT DESIGNED TO DIAGNOSE!!! 111 operate a system where you rule things out - the most serious first. So if a call handler can't rule out if a person is having a heart attack or a stroke an ambulance will be advised and arranged for you. How can a call handler, nurse, paramedics or even a doctor diagnose a patient without ever having set eyes on them?!! We are totally reliant on what the person on the end of the phone is telling us!

111 is a signposting service only. If your advised a OOH doctor will call back then that is a separate service. The same with district nurses etc. If a doctor fails to ring you back then that is the fault of the OOH doctors not 111. But there is nothing stopping you from calling back and chasing up the call.

Ultimately we are all responsible for our own health. The system is at breaking point because of the level of demand & expectation that is placed upon it. People want instant answers and are not willing to wait. This clogs the system up for more urgent cases.

I don’t know what the answer is while the NHS is in the state it is

Me either. But it sounds like you are truly passionate and caring so thank you for doing what you do. Must admit, I feel I only have 3-5 yrs of battling the CCG left.

As a current call advisor i totally agree even though I love my job people assume we just tick boxes but we have to answer questions listen for background noise incase things are changing on 3rd party calls we have to be mediators monitor possible safeguarding we are counsellors to people who need us and are there to give advice on anything to cough cold to talking a distressed person through cpr. It's not an easy job but I still enjoy it even if I'm mentally exhausted at the end of my shift.

You’re a better woman than me, I couldn’t get through the training. I found the job impossible.

compulsive, the problem is that the system seems to be missing some basic elements to make it sensible. A&E staff are always complaining about the number of people referred to them by 111 who just don't need to be there.

I came across this when my mother twisted her ankle. I didn't hear about it till two days later, when she was terribly insistent she needed to see a doctor but couldn't get into my car despite everyone's best endeavours. In desperation I phoned 111, more or less to placate her, and when they heard she was on Warfarin they insisted that I had to take her in to A&E there and then. I pointed out that there was very little swelling and if she'd been haemorrhaging since the incident surely she would be very obviously extremely ill, but they wouldn't have it. It was only when I said that the only way she'd get to A&E would be if they organised an ambulance that they finally decided that maybe they'd refer it to a doctor - who predictably decided there was no need to do anything, but at least calmed my mother down.

@compulsiveliar2019 I told the person on the other end of the phone that I had just woke up (6am) my leg was swollen, painful, and purple. He said "I'll just have a word with someone else" came back and said "We reccomend you make an appointment to see your doctor when they open"

Surely anyone with half a brain would have realised that a swollen, purple leg was pretty damn serious.

They may have saved thousands of lives but one life lost is one too many and that could easily have been mine.