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?

111 is for NON EMERGENCY advice

Yes but the point is your average person can’t be infallibly sure of what constitutes an emergency which is why they put their trust into 111.

The examples in the OP clearly put their trust in 111 but from some of the posts here they were fault for doing that. What’s the point of the whole thing then? Only people of a certain intelligence and with enough common sense should use it? I wonder if how they determine intelligence will take into account people’s skills when they’re sick or scared?

We should be able to trust that as a service it should be able to recognise its own limitations and it’s not good enough to sell itself as a medical service if it can’t do that.

Firstly 111 are not there to diagnose.
If nurses answered all of the calls can you imagine the expense?. The NHS is already in limited resources. Nurses are present for advice.
An ambulance is never sent out without a patients consent. Assessments are only done with what the patient tells the call handler.
People have to take some responsibility for themselves.
If you feel something is not right trust your own instincts. If you need to go to A&E or call an ambulance in which you believe is an emergency then do it. People are too quick to blame someone else. Only you know your own self, your child or a relative.
Years ago you were not able to call an out of hours service you would have had to wait until the morning to contact a GP and even then and certainly now would still not get an appointment.
There are plenty of services out there that can be used.
Pharmacies, walk in centres, 111, A&E, Emergency Ambulance.
Think about your situation and choose Wisley.

I was pregnant, had the most terrible urine infection, rang 111 to get appointment at a local walk in.
I knew what it was.

The 19 year old on the phone ( he said, when I asked) kept asking me daft questions, and then rang back twice more later, to ask more.
I or husband drove me to the walk in, I was ill.

it was a total waste of time, and incredibly embarrassing.

They aren’t medically trained, it was like talking to a neighbour, or neighbours kid about embarrassing symptoms.

It stipulated that you had to call to get an appointment.
I haven’t since, we’ve just turned up and waited.

I thin they need to be constantly regularly evaluating and improving it, based on the conditions being missed

@Orangeblossom78 I can only speak for 999 but if 111 is anything like 999, they will have continuous evaluation and improvement both systemic and individual for call handlers.

@Natsku - that's what we used to have - nurses answering the phone and I think it was much better. They could to a proper phone consultation rather than just asking set questions.

I called 111 after my mum got an infected wound after surgery. Came to my senses though and took her to a and e where she was admitted.

They do have regular audits, and evaluations. Changing any part of the algorithm of questions, even a tiny phrase can require multiple meetings with many levels of clinicians.

A call handler can fail an individual audit if they diverge from the script. There was a brilliant one recently where a family member called 111 after an expected death occurred out of hours and they wanted to check whether a gp needed to certify the body before calling the undertakers. So bearing in mind the caller has called because their relative has died how do you expect the call taker signed off? "If anything changes or gets worse please call us back"

111 call handlers aren’t supposed to diagnose you, that’s an unfair presumption in your title. They ask medics to call you when necessary, so you can discuss with a professional if the situation warrants it.

They’re not discussing your problem with you in an attempt to personally diagnose you, they’re reading questions prompted by their software to see where is the most appropriate place of treatment to forward you to. This apparently awful algorithm does actually work for the majority of callers, these incidents are rare outliers and therefore not indicative of the service as a whole.

I have never had a problem with it. When I specifically wanted an out of hours GP appointment, I told them and was given one once they confirmed I needed it. They only once told me to go to A&E, it was an unnecessary visit but due to one of my symptoms being a massive red flag their medic couldn’t recommend that I get seen elsewhere. It was annoying but understandable.

I’m not saying 111 is perfect, improvements should be constantly made. They should work on marketing so it’s more clear what this service does/doesn’t offer. They should always work on staff training etc. But it’s not as bad as some of you are making out

They've closed the three walk-ins near me - you have to call the OOH GP number now, which is staffed by receptionists who don't have even 111 flowcharts to go through. And they often don't answer. So 111 is a better bet. I would guess 3/4 of the patients who end up in A&E here start by saying 'I tried to get a GP appt, haven't been able to get one in two weeks, and now I'm really worried..."

My local GP practice used to have five partners and six more GPs with two nurses and the odd locum. Now it has two partners and as many locums as they can find, but never more than about four. And they've merged with another practice where the three partners retired. It's leading to loads of problems where repeat prescriptions get cancelled as the person hasn't had a review, but they can't get an appt within six weeks, so then they either need an override on the system or they do without meds and end up as an emergency.

We need double the doctors we have, which means training more, persuading all qualified ones who have quit back into the NHS, and welcoming ones from overseas with messaging as well as it being legally possible to get visas.

I would say that if you don't like calling 111 they have an online version that you can click through and it can give advice to you. Theres also a general nhs health page which gives great advice and red flags regards specific symptoms you're experiencing if you're not sure if you need treatment.

Basically though 111 is not for you if you feel so unwell that you cannot cope, if you are sure you need to be in hospital then what do you expect them to do on the phone?!? Also a few people have said they'll book an appointment at a&e, that's just not true it's just something that's said. A&e will triage you in arrival and that dictates your place in the queue.

If you want to be seen in a&e and are medically able to get there in a car/taxi just getting someone to take you at that point will get you seen earlier then would be the case if you phoned 111/999 and I say this as a front line ambulance worker! It's not uncommon to spend 3 minutes on the call, then 20-60 minutes waiting for the ambulance, then another 30-40 minutes on scene for assessment and documentation, then the trundle into hospital at normal road speed (generally only see 1-2 patients a month that warrant quick action/blue lighting in), then either you're shown to the waiting room and you join the back of the queue or you join the back of the ambulance queue which will be anywhere from 15mins to 2 hours to hand you over, and at that point the nurse on triage may put you in the waiting room too join the back of the queue!

In our area the 111 service is the only way to get an out of hours GP appointment or home visit. It is the fact that it is such a drawn out process that annoys me, you ring & speak to a call handler, then have to wait for a nurse to ring you back & then wait again for a doctor to ring back again. I have known it take 5 to 6 hours to get through the process, it's no wonder many people go straight to A & E.

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.
I live in an affluent town with population of around 117,000. We don’t have a walk in centre/ minor injuries and after 8pm we don’t have an A&E either. There is an out of hours based at the hospital but you have to go through 111 to access it.
The nearest A&E is crazy all of the time and often has waiting times of 6-8 hours. They constantly put out pleas to the public to stay away!
This is the state of urgent/ emergency care now and it’s awful.

I rang 111 when I woke one morning with a very swollen, painful, purple leg. They asked me if I'd injured it? I said I hadn't. They told me to see my doctor who didn't open for another three hours.
I went to A & E anyway. It turned out I had a massive dvt in my entire leg which could have quite easily gone to my lungs and killed me.

It isn't rocket science that if someone has a massive swollen leg with no injury the chances are it's something very sinister.
Bloody plonkers!

Friend rang who had fallen and hurt her knee, badly grazed and bruised they told her to go to A & E

Even the nurse who first saw me.said they are always sending people for the most stupid things whereas people like me are told to see the doctor.

People are miss-diagnosed, or diagnosese are entirely missed frequently at gps abs a&e. Diagnosis is tricky and fraught with mistakes.

It would be interesting to see what the stats are comparing A&E diagnosis accuracy rates with 111.

@RunningAwaywiththeCircus

It's slightly aside from the thread but bacterial tonsillitis isn't always treated with antibiotics anymore, there's a running joke that if you don't prescribe it'll clear up in a week, if you prescribe then it might be better in 7 days. They're not always needed.

Although it's awful that people have died after calling 111, there are stories in the press of people dying after being discharged from A&E or after visiting their GP. Of course, I have no idea how I would react if my child died through a mistake like this, but I'm not sure shutting down a whole service would make things better or reduce the risk.

If 111 didn't exist then I guess people would go to OOH or A&E. What would happen when you call for an OOH appointment? Would they just book it no questions asked? Surely then, not everyone would get an appointment, so they head off to A&E either under their own steam or call 999. More people then die waiting hours for an ambulance because loads more people are calling. A&E is also full to bursting, waits are longer, people get more sick waiting or people are discharged home when they shouldn't be as the pressure to free up beds is so great. A&E closes to new admissions because it's full, so people have to travel further, or can no longer make their own way due to distance. Inevitably people die at home. I don't therefore see how shutting down 111 helps avoid deaths. I can see how major investment in the NHS could help to improve things but people will still die because mistakes will still be made, because we're human. What I hope is that there would be learning from those mistakes and changes made to avoid them in the future.

I do however think that paediatric first aid and basic illness advice should be taught as part of of antenatal classes. Basic first aid being taught in schools might also help individuals help themselves or know better when to seek help and what that help might be.

They're often unfortunately still prescribed to placate the parent/ there's no evidence that it causes direct harm.

However with recurrent tonsillitis the NHS will remove them in line with NICE guidelines which I've attached below. If it's an ongoing problem which is detrimental to your child, and they meet the criteria then ask your doctor why not.

I rang 111 when I woke one morning with a very swollen, painful, purple leg. They asked me if I'd injured it? I said I hadn't. They told me to see my doctor who didn't open for another three hours. I went to A & E anyway. It turned out I had a massive dvt in my entire leg which could have quite easily gone to my lungs and killed me.

Surprised that didn’t flag. You’d think DVT symptoms would be one of their red flags.

Phoned them last night for DS. 14hrs is when they called back. I get that their busy but it's shocking waiting times. We went to the walk in centre when it opened this morning in the end.

@Equanimitas, I agree about infallibility.

Back in the days when GPs ran their own out of hours services, I rang because I had had d&v for 36 hours, my temperature was up in the high 39s and I felt like death.

The GP I spoke decided that I was having a reaction to the Acyclovir I'd been prescribed for shingles a few days earlier.

When I went to the GP 48 hours later, still very unwell, I gave a stool sample. I actually had campylobacter jejuni, and ended up signed off work for 2 weeks while they waited to see if the ABs sorted it.

I think the 111 service is shocking. I’m waiting for a call back right now. I came out of hospital yesterday. People go there whether 111 told them or not

However the out of hours is dreadful. Here if you want an out of hours alp. It’s either the next day. Or very late at night. Even now. They said they would ring and are way out of the time frame. I spent all day once ringing them. I rang them at 6am. A dr rang me back (after 7 calls to them) nearly 27 hrs later.....

I have a very rare disease (though they’ve recently changed their pathways so as to ask whether you have this condition). It can result in a life threatening emergency. It requires resus immediately. They had t even heard of it before the pathways were started. Which is ridiculous. Even now. With the pathway. They still don’t understand the condition. Which means the whole thing is pointless.

People are dying with 111.

When DH rang them because I was lying on the bed with a heartrate of around 30 per minute., they said they would contact our GP on their ‘dedicated’ number but rang back after a few minutes as no reply from GP (Why? poor show there) and said they were sending an ambulance. It arrived swiftly, I was taken to hospital, received excellent care and had a pacemaker fitted the next day.

Without them we would have had no response from GP and would probably have hung on hoping I would either feel better or more likely quietly died.