111 causing more trouble than it's worth

The 111 staff are probably afraid of being sued and are not qualified nurses.
If it's the Noro virus don't for heaven sake take the bug to a hospital, they don't want it either. 111 should be advising to take rehydration fluids instead and how to prepare them..

Recipes for rehydration fluids are all over the internet, or you can pay through the nose for them from your local phamacy. The right quantity of sugar and salt in the right amount of water is all it is,.

It's unpleasant yes but all anyone can do is to keep rehydrating themselves.

I had a similar experience one Friday night. I am on Warfarin and a huge bruise appeared at the top of my leg. I wasn't particularly worried but the instructions told me to contact my GP.As it was after hours I rang 111 and was told I qualified for an emergency ambulance !! Within 30 minutes a young paramedic turned up followed by a big ambulance a few minutes later. The young man checked me over and said everything was fine. I said I felt very guilty about the 2 ambulances but he said it was quite common with 111. It is clerical staff who answer the phones. They have little or no medical knowledge and tend to panic .NHS Direct used to be answered by medical staff and was thus much more efficient. Talk about a false economy !

I gave up on them years ago. A shame really. But 111 staff are never doctors. They can miss things that are really important or over react.

The absence of properly trained staff on the end of the phone seems to be the problem, but I guess that would be too costly - so we use up ambulance time and A&E time instead, which in itself is costly. The phone answerers just have an algorithm to follow and it seems that the end point is to send for an ambulance.

I used to work in the same building as NHS Direct and later the 111 service, while it was being piloted. NHS Direct calls were all taken by the same type of trained call handlers (unqualified) but there were Nurse Advisers available for follow up who could give self-care advice. The 111 service has far fewer nurses in service.

I believe the issue is not the staff, but the way the service was set up. NHS Direct was established with the clear aim of reducing A&E admissions, hence the emphasis on screening and self-care advice. I believe about half the calls taken were passed to a Nurse Adviser for a follow up call. The presence of these Nurse Advisers in the call centre also meant the call handlers could seek advice and were learning all the time.

The 111 service has no such aim, and far fewer nurses. The call handlers - who are trained to follow a computer system, just the same as NHS Direct - are therefore not under pressure to reduce referrals to A&E and they will inevitably play it safe for fear of getting it wrong. All of this was foreseen by the people I worked alongside in the very early days of 111. I'm afraid the government of the day got it wrong by taking a service that seemed to work quite well and changing it for one that is a mess.

On a personal note, I had a very good experience of 111 last summer. I had an insect bite that turned very nasty with my foot swelling like a balloon on Sunday afternoon. I phoned 111 and was given an appointment at the local treatment centre (community hospital), in and out with antibiotics within 30 minutes.

This is why NHS direct was abandoned for sending everyone to A & E.; 111 was supposed to be better. In the bad old days if you were in difficulties you rang your GP surgery, were told the Dr on call number and you rang them, they advised first, asked you to meet them at the surgery second or if they thought it appropriate visited. Only rarely did they phone for ambulances. Now they are paid enormous salaries and cant be reached out of surgery hours. There are 14 GPs in our surgery surely they can get a rota together, they also have highly qualified Nurse Practitioners who could be on call - for a payment of course.

That's the word I was searching for Mishap - an algorithm! NHS Direct used that as well, but with proper backup as I said.

At lunch in the village pub yesterday I overheard someone tell the others that one of the list of questions 111 operatives have to ask is "Are you conscious?"(now this may be apocryphal but never let that get in the way of a good story! )

While DD was here over xmas she called 111. She had sprained her ankle a few days before coming up, and had developed pins and needles that wouldn't go away. She googled it and every site said 'go to A&E if you have persistent pins and needles'. So she rang 111 and after various calls, each giving her differing advice and ring-backs, a doctor called her - and told her to see her own doctor when she returned home! She must have spent two hours on the phone for that. As it was late on a Friday night by then, she didn't really want to go to A&E anyway, so we just strapped her and iced her and treated her ourselves.

She went to her own doctor, and even he couldn't explain the pins and needles phenomenon apart from her having perhaps trapped a nerve because of the swelling, but we did find the whole process rather unsettling and not at all reassuring.

Teetime NHS Direct wasn't abandoned because it was "sending everyone to A&E". It was abandoned in an attempt to save costs by reducing staffing costs. According to an article in the Guardian in August 2010, "forty per cent of NHS Direct's staff are trained nurses, but anyone dialling 111 will speak to non-specialist "call advisers" who have completed a 60-hour course rather than a degree...."

In September 2013 a report - "Impact of the urgent care telephone service NHS 111 Pilot Sites on a controlled before and after study" was released:

"Conclusions In its first year of operation in four pilot sites NHS 111 did not deliver the expected system benefits of reducing calls to the 999 ambulance service or shifting patients to urgent rather than emergency care. There is potential that this type of service increases overall demand for urgent care."

There is now strong anecdotal evidence (two examples are given above) and also, I believe, statistical evidence to support the contention that NHS 111 bears some responsibility for the inappropriate use of the emergency services.

Eloethan It wasn't so much that NHS Direct was abandoned, more that they could not afford to provide the service at the rates the Government were prepared to pay, when the 111 service was introduced and it was put out to competitive tender. NHS Direct was one of several providers who won contracts.

But whereas they were previously paid £20 per call, when 111 was introduced, this went down to £7 -9 per call. No wonder not many qualified nurses are employed by the providers still involved.

more detail here

Can I put in a bouquet for Walk-in Centres here? I know they do not exist everywhere but when DH had signs of internal bleeding -of course on a Saturday afternoon - they saw him in pleasant surroundings, no drunk and disorderlies, albeit after a bit of a wait, and after an examination referred him to our local hospital not via A&E where he then spent a week.

I am stunned by the stupidity of whoever arranged this fiasco, probably under the heading of "efficiency".

Hear, hear for walk in centres, we've used ours as have the GCs. They are the way forward! x

Can you explian how walk in centres work. Pretty sure we dont have them anywhere in our area. I want one <stamps feet>!

On the plus side we do have an excellent, what I presume is classed as, a walk in physio department.

They do what it says on the tin. They are open 7 days a week, you walk in, give your details, say what is wrong and wait for one of the duty doctors or a nurse to see you. You will usually have a bit of a wait but they can diagnose, treat, or refer e.g.to hospital in the same way your GP can if you go to him/her during surgery hours. I think ours is officially called "Critical Care Centre" and they are basically centralised out of hours surgeries for "one off" incidents. Most areas have them but if you live right out in the country I suppose you might have a bit of a drive. They are NOT however an ambulance destination, you have to be well enough to at least limp in!

So the same as the out of hours service? Though I dont think you would go there if you were critical.

"One in four NHS walk-in centres – set up in the past decade to improve patients’ access to urgent health care – have been closed since the election, an official report has found, amid a mounting crisis in accident and emergency care.

Health watchdogs said patients have been left with nowhere to turn after the closure of more than 50 of 238 clinics, which were introduced to relieve pressure on casualty departments.

Regulators said that demand for the centres has remained high, with most closing because of financial pressures – in some cases because they were “too popular” with patients, and costing the NHS too much.

The warning was issued as Prof Sir Bruce Keogh, NHS medical director, prepares to publish recommendations about reform of urgent and emergency care, amid growing concern that the health service could be facing “its worst winter ever” and fears services could buckle under the strain.

Sir Bruce will call for sweeping changes, with fewer patients taken to hospital, and more treated by paramedics and community nurses in their homes, to tackle an “inexorable climb” in A&E attendances and soaring demand for walk-in-centres."

This was in the Telegraph in 2013.
Walk in centres were set up by the Labour government to ease the pressure on A&E, but they were doing too well! Keogh's changes did not work, did they?

Durham was one of the areas where 111 was piloted, and it worked well after two years. Unfortunately, instead of bringing it in piecemeal, the present government changed the rest of NHS Direct to 111 overnight, on April Fool's Day, 2013.
Soon, you could not have given up on 111 years ago, as it has been in existence for less than two years.

Then I am a month or two out then. They went overboard once, and underboard once, so we havent used them since.

Well we have and DH was critical enough to spend the next 6 days in a hospital bed. He could have gone to A&E but the point is that if you are "walking wounded" it is unfair to increase the pressure there. DH needed to be seen by a doctor and that doctor was NOT dealing with the drink/drugs overdoses or the very poorly victims of accidents.
Don't understand what you mean by overboard once and under board once so we haven't used them since. I got the impression you hadn't used them at all. Perhaps you were referring to the 111 service which you say you gave up on years ago despite the fact it has only been in existence since Ril 2013?

Our local walk in centre was saved by public demand, even though 3 miles from an A&E hospital. People power! x

April 2013.

When we lived in York, we were halfway between the walk in centre and the hospital. When my grandson was in his playpen he bounced too much when we were looking after him, and bit his tongue. There was rather a lot of blood, so I phoned NHS direct. They told us to take him to the walk in centre rather than A&E as it would take longer to see someone at the A&E.
He was fine, in the end, but was seen almost as soon as we walked in.

Why did this government close some walk in centres? They did/do what they were supposed to do, take the pressure off A&E. I note that now they are talking about having GPs at A&Es, which does not make sense to me. GPs should be in their surgeries so that fewer people go to A&E.

Here in East Sussex we have to use the 111 number to get a doctor out of hours. Is that what happens elsewhere.?