To think this should have been picked up sooner?

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DD has been ill the last few days with tonsillitis. She called me yesterday morning at 5 a.m., telling me her tonsils were so swollen she couldn't breathe. She has anxiety, so I assumed it was a panic attack, and she did seem to breathe more easily once she calmed down, but she still maintained her breathing was restricted because of her tonsils, so I directed her to the pharmacist (still believing it was a panic attack/anxiety)

The pharmacist looked in her throat and told her that her tonsils were swollen and that he could see "white stuff," but ultimately, there is nothing that can be done for tonsillitis, so he sent her home with a throat-numbing spray and advice to rest and contact her GP if it got worse.

She came home very distressed, which I still believed was anxiety, but I told her to contact her GP if she was in enough pain that she felt she needed to be seen that day. I heard her on the phone telling them one side of her throat was more swollen than the other side, and it was making her "feel" like she couldn't breathe easily. She also told them she'd not eaten in 48 hours as she couldn't swallow but was managing small sips of liquid with difficulty. She was told there were no appointments and nothing could be done for tonsillitis, so try to rest, drink plenty of fluids, and call 111 if it gets worse.

She tried 111 immediately but kept getting directed to a voice message giving her details on how to find an emergency NHS dentist. She was in too much pain to keep trying, so she put the phone down and went to bed in tears. I did manage to get through on 111 on her behalf, who also said it was tonsillitis and to rest/drink fluids, but to call back if it got worse.

The second I finished work, she was up begging me to take her to the walk-in center. I did, but at this point, not being a medical professional, I still thought it was tonsillitis and anxiety.

As soon as she was seen, they told us to go to A and E immediately and to call 999 if she felt like the swelling was worsening on the way there. The on-call ENT specialist was called out to meet us there.

It turns out she had an abscess on her tonsil, which is very serious because it can worsen rapidly and prevent breathing. People have died from not getting treatment quickly enough, apparently.

AIBU to think this should have been picked up by the pharmacist, the GP, and the 111 algorithm? The main warning sign is one tonsil being significantly more swollen than the other, which she told all three services, along with trouble breathing and swallowing.

I realise I didn't help by dismissing it as anxiety, but I am not a medical professional and wasn't aware that tonsil abscesses were a thing, let alone a potentially life-threatening thing.

I agree, I’m also a pharmacist and as I said up thread, I’ve sent someone to A&E previously who did indeed have a quincy. We are trained in recognising red flag symptoms and safety netting. It’s not the fault of all Pharmacists that this one didn’t do their job properly.

I think the OP is getting a really hard time here.

This is the problem.
Too few doctors and people are left not knowing what the heck to do. m

OP, I hear you, one of my daughter's has severe health anxiety and so often has symptoms that in another person would be highly alarming, but this is part of their anxiety syndrome and can't be acted on every time- such as dizziness, palpitations, out of breath, struggling to breathe.

That's precisely why you need a doctor to assess the presenting clinical signs in person, not a self-report over the phone!

You aren't equipped to do this, nor is she (and having an anxiety disorder doesn't mean you aren't ill, as HCP's should know).

The case of the paramedic who dialled 111 and was fobbed off and died of quinsy is very upsetting. Poor him.

Getting a post deleted on mumsnet is one thing, but it doesn’t stop a complaint being made to a workplace.

I think the point is that it could affect other patients.

If quinsy wasn't serious, I very much doubt that our urgent care Dr would have bothered the on-call ENT specialist to meet us at the hospital (note on call - he was not at the hospital, he was called to the hospital because of how serious quinsy can be).

You're right that if it is treated early, it doesn't become serious, but this is my point, it was only treated in time because DD kept moving herself further up the triage chain against the advice she was being given.

If she'd taken the advice to stay home and rest, who knows what could have happened?

Your advice is dangerous. You have shown a lack of empathy. You have revealed details about patients you have treated on other threads. You have said that you have laughed at some of the names of the children you treat. It is unprofessional, so no, it’s not unfair to make a complaint.

I know a child who was treated at that hospital. I’m left thinking have you gossiped about her, laughed at her name and shown a lack of empathy to her and her parents.

I agree that most doctors are fantastic and their knowledge and experience are invaluable with more complex cases. And of course GPs have their own competencies and have to refer to secondary care as appropriate. I see pharmacists and other HCP professionals referring to GPs when appropriate as a good thing, no?
However what we’re talking about here is 7 conditions that are fairly straightforward with the right training and red flags easily identifiable. Being able to recognise quinsy and the other differential diagnoses are not difficult. I have messaged five doctors since your message, none of them had seen a case of quinsy, apart from 1 who saw it on work experience before medical school, before starting practice. As a non clinician yourself you maybe unaware of the years of training a pharmacist undertakes. In my training, which will be the same for other pharmacy universities due to accreditation of the GPhC, we had extensive training on minor conditions that included the throat, skin etc with practical skills tested. I understand your point that pharmacists will never see the amount of patients and complex conditions a GP will however that is why there are only 7 conditions we are able to treat. The poor professionalism of this pharmacist does not represent all pharmacists.
You refer to colds and hayfever being part of the pharmacy first pathway, these conditions are not included. These are things we have been advising patients on for free for decades. As a non clinician it seems you have misunderstood the pharmacy first role, plus all PF consultations must be recorded so pharmacists are unable to do the bare minimum, as you put it, whatever you mean by that.
The concern I have with PF is the amount of pressure it is putting on pharmacists and pharmacies without added support from the government. As unlike doctors and other HCPs in a practice, no matter what our workload is, there is only one of us. Along with the contraceptive service, ABPM etc it’s a lot for one individual to manage. If you brought that up I would agree with your point.
I would also caution just because something has been happening since before our lifetimes, doesn’t mean it’s the correct way to go about things. You bring up that pharmacists roles are vital but we can’t spot differential diagnoses (we can and have been doing for years before PF, e.g. patients comes in with a rash and we signpost as we can see it’s actinic keratosis) however these things are always on a scale. PF doesn’t expect us to determine differential diagnoses on more complex conditions. On the same point, I was a hospital pharmacist before my role now and I observed many junior doctors make some horrendous prescribing errors that a new pharmacy graduate would never make. Does that mean doctors shouldn’t prescribe and only left to pharmacists? Of course not but it’s basically the same argument your trying to make but in reverse.
How do you know pharmacists have the least amount of medical training as a non clinician? For what we’re allowed to do we are trained very well.

I never said colds and hayfever were part of the pharmacy first pathway. I'm aware they're not. I'm also aware of the training pharmacists receive, which is not in any way similar to the training doctors receive, and rightly so as it is a completely different skillset. As you mention, a lot of junior doctors in hospital are flakey as hell on prescribing, which is why pharmacists are considered one of the most important factors in patient safety - they spot and stop so much potential harm.

I have had endless discussions with people in primary care about what constitutes 'straightforward' and 'uncomplicated' cases. The fact is that the boundary between 'uncomplicated' and serious isn't always easy to see, even if you're a highly experienced doctor, which means that for pharmacists and for physician associates (who have a much worse track record for patient safety) the potential for near misses or never events is so much higher than for doctors - unacceptably high in my view.

The doctor and 111 didn’t see her so couldn’t really diagnose beyond tonsillitis but could have warned her of signs of abscess.
pharmacists are not doctors, whilst they can be helpful you should always seek medical advice if still not sure.
Could you have managed it better, yes probably but we all make mistakes and you are not medically trained either.
Thankfully your dd advocated for herself and got the help she needed in time.

I see but your sentence read like you did.
You’re right in the sense that doctors and pharmacists training are rightly different but what I’m trying to make clear is that for the seven conditions that pharmacy first treats are very simple conditions and a pharmacist is more than capable (of course with exceptions of the poor professional in this case) of treating these, even with their differential diagnosis under a PGD. And safety netting advice is always given, just as it would be with a doctor. Please remember we are not prescribing here, we are doing so under a strict PGD criteria.
I also want to tackle your statistics or near misses in pharmacy first consultations as you seem to be grouping us with PAs. That is like comparing apples and oranges, PAs have such a wide variety in training and would agree that PAs should not be given this responsibility. I am only talking with regards to pharmacy first, I think you may be surprised by the statistics. Also new pharmacy graduates are becoming independent prescribers, this is something that is going to become more common and I think a lot of healthcare is gate kept by doctors when other professionals could be utilised much more in a safe manner.

The pharmacist looked at it and sent her home.

If they were in any doubt, they should have suggested going to a doctor.

They have extensive training which is why in the UK we are told to see then first about minor ailments. But they also have very clear guidelines about what they can treat and what they can't and are supposed to be able to tell the difference.

I would suggest giving that particular pharmacist some feedback. They need to know they messed up.

I had tonsillitis 2 weeks ago. The first day I went to the chemist and they gave me antibiotics. 2nd day my throat was so swollen I was struggling to drink water and swallow my own saliva. I did a triage form for my GP and they called me immediately to make an in person appointment. She took one look at my throat and sent me to A&E.

Your daughter’s GP should have seen her. I would complain as she was struggling so much and needed to be seen.

I didn’t eat for 5 days but my dr said as long as I could sip water they weren’t worried. I had slim fast and protein shakes. Sadly I’ve gained back all the weight I lost! X

I’m confused at your double downing OP. You’re outraged your dd wasn’t given antibiotics and treated properly, but when you’re accused of dismissing your dd’s needs yourself, you get defensive and say “Tonsillitis doesn't always need antibiotics.” 🤔

I’m a prescribing pharmacist in Scotland, where Pharmacy First has been going longer, and is more comprehensive. I would have prescribed antibiotics and given strong worsening advice, with emphasis on going to A&E and advice about sepsis. It is disrespectful to say we aren’t competent, if you are a prescribing pharmacist then you are highly trained, and will refer urgently any thing you aren’t able to treat.
However the pharmacist your daughter saw was incompetent, and I would complain.
it massively upsets me when colleagues act so badly and let the ones of us who are doing a good job down. I’m proud of what I do, and my patients are very appreciative. They trust me, and know that if I say I can’t treat them, then I will get them a GP appointment or direct to A&E. So disappointing. I hope your daughter recovers soon. My (Now 18 yr old) son got a quinsy when he was 18 months old, having been repeatedly dismissed by our GP, so I am always mindful when treating a supposedly simple sore throat

I don't believe I ever said I was outraged, but I am confused as to why people believe I am unreasonable for not knowing she needed antibiotics/emergency treatment, but that it is perfectly reasonable that a prescribing pharmacist, a nurse in a GP surgery whose job it is to screen who needs emergency appointments and who doesn't, and the 111 algorithm didn't pick it up.

The guidance we are given is to see a pharmacist for tonsillitis, which I told DD to do. The advice is not to talk to a pharmacist, but don't expect them to be any more knowledgeable than a parent with access to Google.

I will ask her which Boots she went to and email them to let them know they got it wrong this time, and that particular pharmacist might benefit from some further training.

Hoping your daughter is feeling a lot better OP.