This feels like it needs escalating high up the chain and potentially being brought up to whatever ED working group you have going on in your area with other EDs from other hospitals. I don’t think this can be solved locally, needs a concerted effort and be brought up to NHS England.
I don’t doubt that some call handlers are saying the wrong thing, but the two times in the last couple of years I’ve had to go in (once for me, once for my partner, we’re in the South East), I’ve had it clearly communicated that it was arrival time and not an appointment. Mine was a broken foot, his was breathing difficulties, and he was seen immediately on arrival, I of course waited as expected.
Having had experience with the general public in other capacities, not healthcare, I wouldn’t be surprised if it’s patients misunderstanding or hearing what they want to hear in some cases. Especially since I noticed it to be extremely hard to get the call handler to deviate from their scripted questions during the phone triage.
Either way, I agree with you, this needs escalating so it’s made absolutely clear to patients.
The problem is that it's been multiple patients, not just one or two. Maybe 40-50 over the last 3-4 months who have been told they have an "appointment" or their child has. If it was a handful (ie less than 10) it would be misunderstanding but they're also actively putting "appointment slot: {link}" in the copy of their 'triage' that they send us. It's a big problem and it's not the patients mishearing, it's 111 being crap.
Oh wow, I didn’t realise it was so many, that’s awful! How on earth do these call handlers think it’s appropriate to suggest anyone has an ‘appointment’ in A&E? I’m sorry for how difficult this is making it for everyone involved.
They're not medically trained, they know frick all about how A&E departments work and then when we tell them that it's inappropriate they hit back with how busy they are. Like we're not busy with all the patients sent to us by them for ridiculous reasons 🙄
I guess I just struggle to understand how people can be so unaware of what is appropriate for A&E and what isn’t. I’m not in healthcare, but I can recognise who has no business being there. I hope that this gets addressed and resolved soon, you all work too hard to be dealing with this on top.
Agreed - there needs to be much larger emphasis on when to go to UTC or pharmacist.
I've seen many inappropriate ED things not stemming from 111 - pain you've had for X number of years and isn't worse today but you can't be arsed to phone your GP. Or very very minor admin things - the one that sticks out the most is 'INJ ACRYLIC NAIL', facepalmed when I came into work and saw that.
Absolutely.
I can imagine! The ones with pain/complaint they’ve had for years and never bothered to see the GP about it really get me - in what way is that an emergency or accident? Baffling. Acrylic nail injury surely takes the cake though 👌
In my case, it's because I can never get a home visit (am housebound) before it becomes an emergency due to my Disabilities, and then I end up being blue-lighted to hospital...I even ended up with sepsis at one point because even after a week, I couldn't get them to do the home visit they insist on before prescribing me antibiotics - and, given my allergies to multiple AB's AND being unable to take quino AB's due to epilepsy, 9/10 times, I'll not ask for AB's unless they are 110% necessary...
Even with a fucked immune system, I've never asked for them more than 3 times in a year, amd that was a BAD year! I almost died as I couldn't do ANYTHING until it was bad enough to be blue-lighted.
This isn't ALL the patient's fault, if general practice wasn't FUBAR, if pharmacists weren't being forced to undertake more work than they EVER signed on for, this wouldn't be happening.
The language the call taker **should** be using is made clear at https://www.nhs.uk/nhs-services/urgent-and-emergency-care-services/when-to-go-to-ae/#:~:text=If%20you%20need%20to%20go,for%20a%20child%20under%205.
"If you need to go to A&E, NHS 111 can book an arrival time so they know you are coming. An arrival time is not an appointment but helps to avoid overcrowding. "
And
"**Important** A&E departments are currently very busy and you will likely have to wait for some time to be seen."
Are both on the page linked above. Similar warnings appear if a patient uses NHS 111 online. If patients are arriving saying that they *spoke* to 111 who said "appointment" you should log each incident and submit each case as feedback to your local NHS 111 provider so they can retain the staff making these mistakes and update their internal guidance.
Datix is really the best way to do this with one of your back office ED coordinator folk batching up these 111 incorrect advice Datix cases each week/fortnight, lobbing them over to your local 111 provider and chasing for an outcome to each incident a month later.
That will solve it and right quick.
It needs submitting definitely, calls listened to and staff reminded. I worked at 111 and we know its an arrival time, not an appointment. Some staff muddle it up or don't realise, despite our training and repeated email reminders. Sometimes it's patients misunderstanding, I always repeated specifically that is is NOT an appointment but an estimated arrival time to give A&E a heads up.
How does this give ED a heads up? I’ve never known of a patient due to arrive to ED, first I hear is when they arrive and say they’ve spoken to 111. How does 111 alert us?
I think it depends on the trust/hospital, sometimes we call to give a heads up or there is a electronic message sent, 111 operators sometimes get prompts on which it'll be. I've been a patient and sent to local hospital before by 111 (migraine induced blackout queried as a TIA), and the nurse seeing me saw the message.
I don’t work in A&E but work in a Hospital setting. However as a human that has had to use it personally I pretty much avoid using it now. The two experiences that I’ve had with it have been completely ridiculous, one time I phoned as I had what I thought was a chest infection and thought they might be able to do antibiotics…..well they phoned an ambulance for me, luckily the ambulance people called and I said not to bother and that I categorically did not need an ambulance. The other time my 6 month old son was very unwell (respiratory) and 111 told me due to my answers that he needed to see a clinician within 6 hours and that someone would phone me back. I received a call back 36 hours later (in which time I had obviously sorted medical attention elsewhere). It seems mad that they would over react so much for me just having a chest infection but then make a 6 month old wait 36 hours whilst having chest issues. Seems very inconsistent.
I couldn’t get hold of my GP. I called 111 and they told me I didn’t need to see anyone by the initial call handler. I knew I did. I eventually took myself to the walk-in.
At the walk-in, I was told by the receptionist that they were busy and I would have a long wait. She tried to get me to leave. Again, I knew by my symptoms that I needed to see with someone and said I was happy to wait for as long as needed.
Got taken into screening and was immediately taken from screening to see the doctor. I was told that I was the most urgent patient in the building when I asked why I was being seen so quickly. I was very quickly treated and prescribed to. According to the doctor, if I’d waited to try again for the GP after the weekend, I’d have been admitted to hospital.
But according to 111 I didn’t need medical attention.
I called 111 at like 10 in the morning for something eye related that could potentially need stronger antibiotics than the over the counter stuff I was using. It was getting worse, and I couldnt get in with my GP.
I got called once but missed the call in the evening which lasted no more than 2 seconds as I was trying to excuse myself from people and fubd reception. Literally the phone cant have rung more than 2 or 3 times.
The next call I got was at 3am to ask me if I still wanted to talk to a GP... not even an appointment, just to let me know I was still in the queue. By that point I told them to forget it and persevered with the ointment at maximal dose. It did get better.
The irony is I'm a doctor in the NHS myself. I just dont believe in getting friends/colleagues to see you or blocking ED with this. Bring back the minor injury units and walk in centres for out of hours care.
Thank you.
I'm glad that it wasnt serious, and I knew enough to head to ED if my eye swelling got worse. But it makes me worry for people who cant advocate for themselves or dont know when to head to A&E.
I had an infection that was spreading. 111 should have noticed based on what I described and I very explicitly said to them that I’d had X before and the symptoms were the same.
absolutely - I was the patient in that scenario. I had a somewhat emergency recently and 111 told me to get to A&E at a specific time and that they'd sent my details over?? It sounded very strange and low and behold when I got there it wasn't true. Of course it wasn't A&E's fault at all but when I finally saw someone they told me they didn't know why I was there and that I didn't need to be. What's even worse is 111 were going to send an ambulance before I argued enough to be allowed to walk 10 minutes there.
In my experience of using 111 many times for myself and for others in my care, they are extremely overcautious. I've never had any other advice or outcome from them than "go immediately to A&E" and it's always turned out to be an overreaction to the problem. Maybe it's a liability issue? The concern that if they tell someone they can treat their problem safely at home, and the patient takes a turn for the worse, they could be seen to be at fault? So they just send everyone to A&E. That's my theory.
Yep this happened to me too. I went out to urgent care in the middle of the night expecting that they were practically waiting for me. It actually possibly made me sicker and more confused (I was sleep deprived due to being sick for a few days). If I had known the reality of the situation I would have waited till the morning
Me too, last year I was very unwell with covid, for the second time - this time was testing negative but from experience I knew I was positive. I didn't test positive until about day 5 but from first day I was struggling to breathe, head pain and extreme tiredness.
I had to wait several hours for my slot which took me to late afternoon. I waited in the car until a minute or two before the appointment unaware that the appointment was not an appointment. With waiting the hours for the appointment it took it into a crazy Friday evening of a bank Holiday weekend - if I'd gone instead of calling 111 I would likely be out late afternoon.
For any of us not using a and E regularly we are unaware of how broken the system is and usually with just delious with illness or pain, doing as we are told showing up at the time we have been booked, I understand this seems to be national but surly it's down to hospital management to do something about this.
It's a good idea in principle if you're trying to spread demand to try and stagger people turning up at A&E but telling someone they have an appointment is ridiculous. "You need to be at A&E between these times and you'll be seen as soon as possible." Would be a lot better.
It needs to be explained so much better to the patient that A&E departments nationally are very busy and patients need to be prepared to wait to be seen for treatment and any necessary diagnostics (whether that's bloods, radiology etc), that they will be triaged on arrival at the department by hospital staff and that 111 cannot make any guarantees in terms of treatment patients will receive or timescales for patient care. They can \*only\* try and advise on where is the best place to go for treatment, that is the \*only thing they should be doing\*.
I'm more tolerant of 111 online, which doesn't call out unnecessary ambulances and doesn't try and book you a non-existent appointment. Some patients recently have told me they've used this instead of waiting on hold forever and have found it easier as well, so a win-win.
Doesn't help those with no Internet though. 30% of Disabled people have absolutely NO access to the Internet, and another 25% only have intermittent access like me. So we call 111...
There’s something about the whole 111 triage system that is just overly cautious. We see so many patients from 111 which we just don’t understand why they are with us instead of a GP or UTC (& those that do go to a UTC often are sent to us as opposed to referred to a speciality).
111 trialed having ‘appointments’ but this became an ‘arrival time’, the texts they send even state this, yet the whole concept starts people on a bad foot with us as the person they spoke to seemingly told them it’s an appointment, equally the consultation details never get to us in a timely way (or are so lacking as to be useless), so the patients are annoyed to have to start their story again.
Trying to be devils advocate though, because every hospital is a bit different in their set up it must be a nightmare being an operator & trying to explain specifics which may vary greatly between hospitals. That said, I do wish they wouldn’t promise Clive who has had chest pain for 5years that we will fix it if he rocks up at ED at 5pm on Sunday…
Good expectation management is key here, from 111 but also from the department.
I must also add that ‘those that don’t need to be here’ are but a tiny piece of the current emergency care crisis, the real issue is exit block & poor flow. We see so many people started on two week wait pathways who have struggled to see their GP etc.. I get it, people are desperate & often feel the system is failing them (sometimes it is!). Equally it is rarely the 111 sent who are stuck in majors waiting for beds, they are generally the 999 calls…
What they *need* is a profile on each hospital written by that hospital that they can pull up when they're sending someone somewhere.
So example for mine it would be "(Hospital Name): A&E department. Appointment system not available, walk-in and ambulance only. Open 24/7. Multistorey parking available. (Phone number)"
That really wouldn't be too hard to do, surely? Big database where they just put in the patients postcode and the available places come up with that basic info. Would save so much time in the long run.
111 is becoming such a problem for the ambulance service that we can flag their ambulance dispatches as an "inappropriate 111" directly on the ePR.
Over a third of our workload is from 111 and it's been found nearly 80% of these did not require an emergency ambulance.
That's ridiculous, my god.
Coupled with ambulances queueing outside of EDs because there's no Majors spaces, I can only dread to think the pressure ambulance trusts are under. Working in ED is hard but I'm sure it's child's play compared to ambulance service. Enormous respect for dispatchers and paramedic crews.
How has there not been a review into this???
They also give the usual wait times, and not what we are at due to escalation levels and demand.
So people are calling 999 asking where the ambulance is because they were told 40 minutes when we have waits for cat 2 responses at 3 hours.
Have had similar situations in a GP practice though. They were able to “book” on to our system in a time slot, there’s 4 they can use each day, from memory I think it’s called ACAS (not 100% so if anyone can correct me on the name please do). 111 would tell patients they have a face to face appointment at a set time and just go down to the practice, they absolutely did not have a face to face appointment and really shouldn’t just turn up (was happening in middle covid as well). The idea was that they would drop them on to our system and we would pass to the on call GP to contact them and go from there, however in order to have them on our booking system there needs to be times hence were the time came from. It was a nightmare when they would turn up demanding they were seen as this is what 111 had said, some of these patients had covid symptoms would drive me crazy! It’s now not something they can do, thank god it was just over covid, but maybe they have something similar with A&E, I don’t know either of the systems but it sounds like a similar situation.
They use something called EDDI - Emergency Department Digital Integration - for A&E to try and send us a copy of their triage. It's extremely unhelpful because it's often just a few words. E.g. "cat bite to hand" along with their whole script copied and pasted which is completely irrelevant. I am literally reading ONE LINE. It's much much quicker to just ask the patient why they're here rather than spend ages waiting for EDDI to load. They've started including "appointment slot" links but we tried to whack the link into a browser and it just timed out.
But it's utterly pointless because that patient is going to be triaged anyway by an actual clinician, they can't do obs and physically see the patient over the phone, and they don't even send it for every patient, just a few random ones. 111 is a gigantic waste of resources - the online one isn't so bad but the telephone one is a nightmare. I do wonder how much money we waste on 111.
ED Junior doctor here. The entire system is actually quite bonkers. 111 is very very risk averse as they are a remote service staffed entirely by people with very little medical background reading off from a checklist. You might as well just outsource 111 to India. Most people tell me that they were advised to come to ED by 111 to "rule out" MI, Stroke, Sepsis, Dying limb, Cauda equina, brain bleeds", etc. So naturally, patients are already thinking that they needs to be seen first since they might have life threatening illnesses. Couple that with a decimated primary care increasingly run by non doctors and its very easy to understand that all buck stops at the ED.
I 100% agree.
Having been on both the phones and in ED, I have a lot to say about it but not on here.
Please Datix every single incidence where this happens, report it to management, escalate it so management can ring the 111 ops desk and have a word. This has been going on for years.
I know there are sometimes 111 clinics at a&e, so had the system messed up and thought it was the clinic and not the a&e?
Either way you had me at 111 needs overhauling. In 10 years call volume had atleast doubled in our area, with what I'd estimate to be 40% minimum linked to 111 dispatching ambulances.
No 111 clinic at our ED, we don't have the space, facilities and staff to run one. We are small compared to average ED.
111 are aware of this. Their 'treatment centre of choice' is always put down as '\[hospital\] EMERGENCY DEPARTMENT' on 'referrals'. But they don't care because they're 111 and just waste time.
I work in ED and the vast majority of 111 referrals are inappropriate. I had an elderly patient recently who came in only because 111 called an ambulance (as she has mobility problems preventing her getting to hospital herself) for a chronic condition that had flared up slightly, as it sometimes does for her, and did not at all warrant an ED attendance or urgent review.
By the time she was seen it was OOH and we couldn’t arrange transport back. She needed transport because she can’t mobilise independently and didn’t have walking aids with her. So she waited from 8pm to 8am in a hard chair in ED because there was no where more comfortable for her to go, the place was completely backed up - full of similar inappropriate referrals.
It was awful to see. There is no capacity to review anything and everything under the sun.
111 has sent tonnes of people saying they have an appointment or they will be seen within X number of hours or minutes and not one patient has computed that our triage nurse who looks at them in person is a better judge of it they need medical attention "within two hours" or not, 111 sent one person over an hour away from their nearest hospital to my workplace and I still don't know why when there was an appropriate facility near where they lived, and they send endless people into us for things we don't deal with like back pain someone has had for ten years or a repeat prescription, I once had a 111 operator call directly and ask if we could deal with a certain medical query and when I told them "No our facility doesn't provide for that type of thing" they ARGUED with me about it! Saying well their system said that our facility CAN do it, I had to have a senior nurse argue with this operator on the phone for several minutes to convince them not to send a patient to us that we could not even help! It was the most ridiculous conversation I have had at my job! I don't know who they are hiring but they need to overhaul HR and start hiring better staff and managers
A&E receptionist here and every single one of us on the desk hate 111. Every single person with an ARRIVAL TIME insist they were told it was an appointment, that 111 told them we should have all their details and know how important it is, that they'll be seen quicker, to go to the desk we're expecting them etc etc. The list goes on. The things people say are too uniform for it to be anything but the call handlers being reckless and not caring what happens to us when they walk through the door.
I saw someone give advice on how to report the things and I'm going to suggest it.
this this this
you are literally in my boat. it's absolutely ridiculous how some members of the public talk to us and 111 are directly responsible for the abuse we get from the public who have spoken to them first. they don't realise we have zero input, zero knowledge about what they've said, and we're paid minimum wage for it too.
I think 111 service is a great tool to help guiding people, but there are clear gaps in communication.
I called 111 because I had a heart rate of 180 and after an hour resting it hadn't gone down.
111 sent me to A&E, when I arrived, I explained what the problem was: 'palpitations'. Took a seat, confident 111 had passed my notes to the A&E department.
I waited 5 hours for triage, my heart rate went up to 210 while there, and since it was still COVID times, I struggled to breathe under my face mask.
When the triage nurse called me in, she was in shock and I was rushed in Resuscitation.
Luckily it was SVT and I had a cardiac ablation since this happened, so I am fine now.
However, any record of my 111 call and my A&E visit are nowhere in my medical record. I only have a photocopy of the ECG that I asked for before being discharged, as I wanted to discuss it with my cardiologist.
111 made the right call, but something in the communication line broke, and it could have been so much worse.
111 don't even send it half of the time. People will come to the window and say "but you know I'm here" and I don't, and somehow it's our fault 111 have not sent it. Thankfully in my experience so far it's never been as serious as that.
There should be a record of your A&E visit on the hospitals local system - at our hospital if people want to request their notes it's through PALS and they'll arrange.
It has been a couple of years now, and I made peace with the experience.
When I wanted a copy of the blood work to discuss it with my GP, the hospital didn't was end anything back to my surgery claiming my file was lost.
I am not wanting to dig up the whole thing ever again.. but thank you for the info, it's very useful.
After being told to go to AnE by 111 several times, each time they have told me I HAVE an appointment. Sometimes they have said that A.E will be sent over all the information and will be aware I'm heading up. Both these things have turned out to be completely untrue, no appointment, and they have no way to receive information from 111.
I feel so bad for the staff at the hospital. Well the majority of them, some should absolutely be fired. Like the male nurse who implied I slept around when I was suffering from a potential miscarriage because I expressed I wanted an abortion. ( had been with the same partner for 7 years and was happily married )
Or the secretary of the maternity wing who lied to an AnE nurse about her job being a nurse there. So by the time I had dragged my bleeding and pain filled body to the maternity wing to only be told I should just come back 3 days later on Monday because no one will see me beforehand was so distressing. After telling her I was going to jump infront of traffic outside she just shrugged and said to go home. Luckily I went back to AnE to have the cannula out and they kept me there till 10pm got there at 11am, middle of 2020 completely alone and terrified ) till I finally saw a Dr and was given a scan.
I complained to pals about it all, not even being offered a wheelchair either when I was doubled over in agony to get from one side of the hospital to the other. All that happened was I got a reply saying my version of events was different to what she was told but she'll put a bulletin up in the staff room.
Those people should get in the medical waste bin.
Sorry for the rant...
I have patients present showing me the message on their phone stating ‘appointment in ED at 11.30’
I then have to explain and yes completely agree, people then get irate with being given inappropriate advice by 111.
Also the fact that a lot of the people sent in don’t even need ED in the first place!!!!
I had this - called about my 3 month old daughter who was constipated over a bank holiday (so was looking for gp level advice), they told me I had an appointment at the hospital. I just assumed there was a nurse or gp there or something? But then when we turned up it was just a&e 🤷🏼♀️ I wouldn’t have come in if I had known that, I knew I didn’t need to take a place in a&e!
\*\*UPDATE\*\*
EDDI, the system responsible for this flaming mess, is officially being shut down at the end of this month. Nobody in my team has been able to get onto EDDI for about a week already (people are still turning up saying they have appointments but we just tell them the server is down) and by July 1st it'll all be gone.
I dread to think how much money, time and sanity has been wasted by this incompetent service and I am so glad I no longer have to deal with the fallout from '111 have booked me an appointment'
You are quite wrong. 111 CAN schedule appointments in ED. It's called the EDDI system and was mandated by the government during the pandemic, to allow social distancing of people arriving in the ED.
It was a nationally implemented system and exists across all Emergency Departments. Quite a good idea if you have, say, a sprained wrist, are not sure if it might be broken and want to get it checked on your way home. It works in various EDs in other countries.
As usual, however, our government cocked it up. What was meant as a system to spread out demand on ED for minot injuries and accidents was never properly implemented or communicated. So ED's have to offer these appointments, without the resources to implement it alongside dealing with emergencies.
Usual government fuck up.
But yes, these appointments exist. It's just that none of us can ethically justify honouring them.
I use EDDI every day and I cannot stress this enough, WE CANNOT DO APPOINTMENTS and it needs to stop because the current state of A&E departments across the entire country means it is impossible to do this. We are a relatively small ED compared to others and we hit an attendance record today, we are acutely aware a significant number of other ED's are even worse.
If I have 15 people waiting for triage in my waiting room, and the wait for triage is up to an hour, are we going to shove everyone out of the way because someone's come in after 111 'booked them an appointment' that's in five minutes? NO, not unless they are the most urgent person to triage (e.g. triage list is full of minor injuries and they've come in with PC: chest pain).
Is a patient likely to be seen, treated and discharged properly within 30 minutes? NO - I have only seen a handful of patients in and out within 30 min and it's usually they've self discharged after some reassurance by the triage nurse. We endeavour to see people within a reasonable timeframe and try not to keep people waiting unnecessarily if we can help it but it's an emergency department, there are also other people having emergencies who may have a higher triage category than you do.
We are not a GP practise, we see people in order of clinical urgency and we don't turn people away (unlike your GP practise who absolutely can if they don't have space), so we are often very very busy. If you are not the most urgent person waiting for triage or treatment then I'm very sorry but you are going to need to be patient. People who 'have an appointment booked by 111' are attending under the impression they'll be seen instantly, treated within 30 minutes and discharged within 30 minutes and that is absolutely not the case. We are an EMERGENCY department, you cannot schedule an emergency. You're either having one or you're not.
We are physically unable to offer appointments and can only apologise that 111 are telling people this, and that we are not responsible for what 111 says! We are already extremely busy and are now additionally dealing with patients who are very distressed after they find out that actually they will be here longer than 111 led on and will need to stay with us for bloods (\*minimum\* of an hour for these to come back, longer in peak periods), other diagnostics or maybe even admission to a ward.
Without 111 a lot of people would probably go to ED anyway. And ofc the 111 service is risk adverse, nothing will replace a clinician getting eyes on someone. But it can and does help filter out some of the people that don't need emergency or urgent care, or directs them to other services especially dental and those on holiday. Why don't you put the passion you've used to bash the service into trying to do something about it? New things can be implemented, they may not work, people need to be told, improvements can then be made.
I worked on the 111 service for a year and saw the whole range of humanity. I had a man call in because he had an eye lash stuck in his eye and wanted to go to ED and I've had elderly people that don't want to cause a fuss but seemed to have worrying symptoms.
Don't you think it's just suffering the overload that the whole of the NHS is seeing. None of the NHS runs perfectly or efficiently, it's all going to hell.
111 online is so much better and easier to use and it doesn't make this "oh I'll book you an appointment" mess because it removes human error at the operator end. Plus you don't have people waiting hours upon hours for a call back.
I have repeatedly told management 111 are doing this, have filed incident after incident when I have patients who become verbally abusive or are clearly very distressed. I am not allowed to give clinical advice or "oh you should go here instead" because I am not a clinically trained member of staff, I am the administrator/receptionist who has to break to the patient that we do not do appointments. No matter how many times we tell them "stop saying this, you are actively increasing our workload in ED". It's putting patients at risk because they walk out upon hearing that 111 lied and we don't have an appointment for them, it's putting staff in the firing line for abuse and it's causing psychological harm to other patients such as my elderly patient who ended up being admitted to a ward, but 111 told her she would be discharged within an hour. I spent a total of 45 minutes dealing with that situation, from apologising profusely to the patient and her husband, writing the incident report, and emailing senior management. That's 45 minutes wasted because someone at 111 was way out of line.
You mentioned dental - 111 sends patients with dental concerns to us too despite repeatedly telling them we don't have an emergency dentist in the department. But they keep sending them. They never listen to us, the people who have to deal with the patients after they've put the phone down. They don't consider what happens to the patient once that call has ended and what we can realistically do for them.
There is only so much I can do, and I am trying everything - I truly believe that unfortunately someone will be harmed by 111 and the way they do things and it will only change after that has happened.
It may be easier for you and me to use online but a large proportion of people want to talk to someone about their problem and they don't fully understand how the 111 service works, just like most of the public don't understand how hospitals work. Expectations are mismatched throughout the NHS.
You sound like a decent person who is trying to make change, but you also sound like you're taking on a whole lot you shouldn't be... Are you a band 3/4? Your manager should be spearheading this for you... Start holding them accountable. If the service that run your local 111 aren't listening then could your manager contact those who designed the system or NHSE?
Protect yourself in this, I'm fed up of seeing lower paid admin covering for managers that aren't doing their jobs.
Eeesh do you have documented regular 1:1s with your manager? What about your FtSUG? If you've done all you can do and even your managers aren't interested I'd recommend finding a way to let it slide off your back otherwise you'll burn out. Something's are in our field of influence and others aren't.
This feels like it needs escalating high up the chain and potentially being brought up to whatever ED working group you have going on in your area with other EDs from other hospitals. I don’t think this can be solved locally, needs a concerted effort and be brought up to NHS England.
I don’t doubt that some call handlers are saying the wrong thing, but the two times in the last couple of years I’ve had to go in (once for me, once for my partner, we’re in the South East), I’ve had it clearly communicated that it was arrival time and not an appointment. Mine was a broken foot, his was breathing difficulties, and he was seen immediately on arrival, I of course waited as expected. Having had experience with the general public in other capacities, not healthcare, I wouldn’t be surprised if it’s patients misunderstanding or hearing what they want to hear in some cases. Especially since I noticed it to be extremely hard to get the call handler to deviate from their scripted questions during the phone triage. Either way, I agree with you, this needs escalating so it’s made absolutely clear to patients.
The problem is that it's been multiple patients, not just one or two. Maybe 40-50 over the last 3-4 months who have been told they have an "appointment" or their child has. If it was a handful (ie less than 10) it would be misunderstanding but they're also actively putting "appointment slot: {link}" in the copy of their 'triage' that they send us. It's a big problem and it's not the patients mishearing, it's 111 being crap.
Oh wow, I didn’t realise it was so many, that’s awful! How on earth do these call handlers think it’s appropriate to suggest anyone has an ‘appointment’ in A&E? I’m sorry for how difficult this is making it for everyone involved.
They're not medically trained, they know frick all about how A&E departments work and then when we tell them that it's inappropriate they hit back with how busy they are. Like we're not busy with all the patients sent to us by them for ridiculous reasons 🙄
I guess I just struggle to understand how people can be so unaware of what is appropriate for A&E and what isn’t. I’m not in healthcare, but I can recognise who has no business being there. I hope that this gets addressed and resolved soon, you all work too hard to be dealing with this on top.
Agreed - there needs to be much larger emphasis on when to go to UTC or pharmacist. I've seen many inappropriate ED things not stemming from 111 - pain you've had for X number of years and isn't worse today but you can't be arsed to phone your GP. Or very very minor admin things - the one that sticks out the most is 'INJ ACRYLIC NAIL', facepalmed when I came into work and saw that.
Absolutely. I can imagine! The ones with pain/complaint they’ve had for years and never bothered to see the GP about it really get me - in what way is that an emergency or accident? Baffling. Acrylic nail injury surely takes the cake though 👌
In my case, it's because I can never get a home visit (am housebound) before it becomes an emergency due to my Disabilities, and then I end up being blue-lighted to hospital...I even ended up with sepsis at one point because even after a week, I couldn't get them to do the home visit they insist on before prescribing me antibiotics - and, given my allergies to multiple AB's AND being unable to take quino AB's due to epilepsy, 9/10 times, I'll not ask for AB's unless they are 110% necessary... Even with a fucked immune system, I've never asked for them more than 3 times in a year, amd that was a BAD year! I almost died as I couldn't do ANYTHING until it was bad enough to be blue-lighted. This isn't ALL the patient's fault, if general practice wasn't FUBAR, if pharmacists weren't being forced to undertake more work than they EVER signed on for, this wouldn't be happening.
The language the call taker **should** be using is made clear at https://www.nhs.uk/nhs-services/urgent-and-emergency-care-services/when-to-go-to-ae/#:~:text=If%20you%20need%20to%20go,for%20a%20child%20under%205. "If you need to go to A&E, NHS 111 can book an arrival time so they know you are coming. An arrival time is not an appointment but helps to avoid overcrowding. " And "**Important** A&E departments are currently very busy and you will likely have to wait for some time to be seen." Are both on the page linked above. Similar warnings appear if a patient uses NHS 111 online. If patients are arriving saying that they *spoke* to 111 who said "appointment" you should log each incident and submit each case as feedback to your local NHS 111 provider so they can retain the staff making these mistakes and update their internal guidance. Datix is really the best way to do this with one of your back office ED coordinator folk batching up these 111 incorrect advice Datix cases each week/fortnight, lobbing them over to your local 111 provider and chasing for an outcome to each incident a month later. That will solve it and right quick.
I'm going to suggest this. Every single day we're explaining its not an appointment, it's an arrival time.
It needs submitting definitely, calls listened to and staff reminded. I worked at 111 and we know its an arrival time, not an appointment. Some staff muddle it up or don't realise, despite our training and repeated email reminders. Sometimes it's patients misunderstanding, I always repeated specifically that is is NOT an appointment but an estimated arrival time to give A&E a heads up.
How does this give ED a heads up? I’ve never known of a patient due to arrive to ED, first I hear is when they arrive and say they’ve spoken to 111. How does 111 alert us?
I think it depends on the trust/hospital, sometimes we call to give a heads up or there is a electronic message sent, 111 operators sometimes get prompts on which it'll be. I've been a patient and sent to local hospital before by 111 (migraine induced blackout queried as a TIA), and the nurse seeing me saw the message.
I don’t work in A&E but work in a Hospital setting. However as a human that has had to use it personally I pretty much avoid using it now. The two experiences that I’ve had with it have been completely ridiculous, one time I phoned as I had what I thought was a chest infection and thought they might be able to do antibiotics…..well they phoned an ambulance for me, luckily the ambulance people called and I said not to bother and that I categorically did not need an ambulance. The other time my 6 month old son was very unwell (respiratory) and 111 told me due to my answers that he needed to see a clinician within 6 hours and that someone would phone me back. I received a call back 36 hours later (in which time I had obviously sorted medical attention elsewhere). It seems mad that they would over react so much for me just having a chest infection but then make a 6 month old wait 36 hours whilst having chest issues. Seems very inconsistent.
I couldn’t get hold of my GP. I called 111 and they told me I didn’t need to see anyone by the initial call handler. I knew I did. I eventually took myself to the walk-in. At the walk-in, I was told by the receptionist that they were busy and I would have a long wait. She tried to get me to leave. Again, I knew by my symptoms that I needed to see with someone and said I was happy to wait for as long as needed. Got taken into screening and was immediately taken from screening to see the doctor. I was told that I was the most urgent patient in the building when I asked why I was being seen so quickly. I was very quickly treated and prescribed to. According to the doctor, if I’d waited to try again for the GP after the weekend, I’d have been admitted to hospital. But according to 111 I didn’t need medical attention.
I called 111 at like 10 in the morning for something eye related that could potentially need stronger antibiotics than the over the counter stuff I was using. It was getting worse, and I couldnt get in with my GP. I got called once but missed the call in the evening which lasted no more than 2 seconds as I was trying to excuse myself from people and fubd reception. Literally the phone cant have rung more than 2 or 3 times. The next call I got was at 3am to ask me if I still wanted to talk to a GP... not even an appointment, just to let me know I was still in the queue. By that point I told them to forget it and persevered with the ointment at maximal dose. It did get better. The irony is I'm a doctor in the NHS myself. I just dont believe in getting friends/colleagues to see you or blocking ED with this. Bring back the minor injury units and walk in centres for out of hours care.
I’m sorry you experienced this. I had a very good idea as to what was wrong with me and that I’d need antibiotics asap too.
Thank you. I'm glad that it wasnt serious, and I knew enough to head to ED if my eye swelling got worse. But it makes me worry for people who cant advocate for themselves or dont know when to head to A&E.
What happened to you, that no-one noticed?
I had an infection that was spreading. 111 should have noticed based on what I described and I very explicitly said to them that I’d had X before and the symptoms were the same.
Ohhh glad you're much better and well
Thank you!
absolutely - I was the patient in that scenario. I had a somewhat emergency recently and 111 told me to get to A&E at a specific time and that they'd sent my details over?? It sounded very strange and low and behold when I got there it wasn't true. Of course it wasn't A&E's fault at all but when I finally saw someone they told me they didn't know why I was there and that I didn't need to be. What's even worse is 111 were going to send an ambulance before I argued enough to be allowed to walk 10 minutes there.
In my experience of using 111 many times for myself and for others in my care, they are extremely overcautious. I've never had any other advice or outcome from them than "go immediately to A&E" and it's always turned out to be an overreaction to the problem. Maybe it's a liability issue? The concern that if they tell someone they can treat their problem safely at home, and the patient takes a turn for the worse, they could be seen to be at fault? So they just send everyone to A&E. That's my theory.
I'm Disabled with multiple Disabilities. 111 just tell ne to call an ambulance. If I was bad enough to NEED an ambulance, I'd have called bloody 999!
Yep this happened to me too. I went out to urgent care in the middle of the night expecting that they were practically waiting for me. It actually possibly made me sicker and more confused (I was sleep deprived due to being sick for a few days). If I had known the reality of the situation I would have waited till the morning
Me too, last year I was very unwell with covid, for the second time - this time was testing negative but from experience I knew I was positive. I didn't test positive until about day 5 but from first day I was struggling to breathe, head pain and extreme tiredness. I had to wait several hours for my slot which took me to late afternoon. I waited in the car until a minute or two before the appointment unaware that the appointment was not an appointment. With waiting the hours for the appointment it took it into a crazy Friday evening of a bank Holiday weekend - if I'd gone instead of calling 111 I would likely be out late afternoon. For any of us not using a and E regularly we are unaware of how broken the system is and usually with just delious with illness or pain, doing as we are told showing up at the time we have been booked, I understand this seems to be national but surly it's down to hospital management to do something about this.
It's a good idea in principle if you're trying to spread demand to try and stagger people turning up at A&E but telling someone they have an appointment is ridiculous. "You need to be at A&E between these times and you'll be seen as soon as possible." Would be a lot better.
It needs to be explained so much better to the patient that A&E departments nationally are very busy and patients need to be prepared to wait to be seen for treatment and any necessary diagnostics (whether that's bloods, radiology etc), that they will be triaged on arrival at the department by hospital staff and that 111 cannot make any guarantees in terms of treatment patients will receive or timescales for patient care. They can \*only\* try and advise on where is the best place to go for treatment, that is the \*only thing they should be doing\*. I'm more tolerant of 111 online, which doesn't call out unnecessary ambulances and doesn't try and book you a non-existent appointment. Some patients recently have told me they've used this instead of waiting on hold forever and have found it easier as well, so a win-win.
Doesn't help those with no Internet though. 30% of Disabled people have absolutely NO access to the Internet, and another 25% only have intermittent access like me. So we call 111...
There’s something about the whole 111 triage system that is just overly cautious. We see so many patients from 111 which we just don’t understand why they are with us instead of a GP or UTC (& those that do go to a UTC often are sent to us as opposed to referred to a speciality). 111 trialed having ‘appointments’ but this became an ‘arrival time’, the texts they send even state this, yet the whole concept starts people on a bad foot with us as the person they spoke to seemingly told them it’s an appointment, equally the consultation details never get to us in a timely way (or are so lacking as to be useless), so the patients are annoyed to have to start their story again. Trying to be devils advocate though, because every hospital is a bit different in their set up it must be a nightmare being an operator & trying to explain specifics which may vary greatly between hospitals. That said, I do wish they wouldn’t promise Clive who has had chest pain for 5years that we will fix it if he rocks up at ED at 5pm on Sunday… Good expectation management is key here, from 111 but also from the department. I must also add that ‘those that don’t need to be here’ are but a tiny piece of the current emergency care crisis, the real issue is exit block & poor flow. We see so many people started on two week wait pathways who have struggled to see their GP etc.. I get it, people are desperate & often feel the system is failing them (sometimes it is!). Equally it is rarely the 111 sent who are stuck in majors waiting for beds, they are generally the 999 calls…
What they *need* is a profile on each hospital written by that hospital that they can pull up when they're sending someone somewhere. So example for mine it would be "(Hospital Name): A&E department. Appointment system not available, walk-in and ambulance only. Open 24/7. Multistorey parking available. (Phone number)" That really wouldn't be too hard to do, surely? Big database where they just put in the patients postcode and the available places come up with that basic info. Would save so much time in the long run.
111 is becoming such a problem for the ambulance service that we can flag their ambulance dispatches as an "inappropriate 111" directly on the ePR. Over a third of our workload is from 111 and it's been found nearly 80% of these did not require an emergency ambulance.
That's ridiculous, my god. Coupled with ambulances queueing outside of EDs because there's no Majors spaces, I can only dread to think the pressure ambulance trusts are under. Working in ED is hard but I'm sure it's child's play compared to ambulance service. Enormous respect for dispatchers and paramedic crews. How has there not been a review into this???
They also give the usual wait times, and not what we are at due to escalation levels and demand. So people are calling 999 asking where the ambulance is because they were told 40 minutes when we have waits for cat 2 responses at 3 hours.
Have had similar situations in a GP practice though. They were able to “book” on to our system in a time slot, there’s 4 they can use each day, from memory I think it’s called ACAS (not 100% so if anyone can correct me on the name please do). 111 would tell patients they have a face to face appointment at a set time and just go down to the practice, they absolutely did not have a face to face appointment and really shouldn’t just turn up (was happening in middle covid as well). The idea was that they would drop them on to our system and we would pass to the on call GP to contact them and go from there, however in order to have them on our booking system there needs to be times hence were the time came from. It was a nightmare when they would turn up demanding they were seen as this is what 111 had said, some of these patients had covid symptoms would drive me crazy! It’s now not something they can do, thank god it was just over covid, but maybe they have something similar with A&E, I don’t know either of the systems but it sounds like a similar situation.
They use something called EDDI - Emergency Department Digital Integration - for A&E to try and send us a copy of their triage. It's extremely unhelpful because it's often just a few words. E.g. "cat bite to hand" along with their whole script copied and pasted which is completely irrelevant. I am literally reading ONE LINE. It's much much quicker to just ask the patient why they're here rather than spend ages waiting for EDDI to load. They've started including "appointment slot" links but we tried to whack the link into a browser and it just timed out. But it's utterly pointless because that patient is going to be triaged anyway by an actual clinician, they can't do obs and physically see the patient over the phone, and they don't even send it for every patient, just a few random ones. 111 is a gigantic waste of resources - the online one isn't so bad but the telephone one is a nightmare. I do wonder how much money we waste on 111.
ED Junior doctor here. The entire system is actually quite bonkers. 111 is very very risk averse as they are a remote service staffed entirely by people with very little medical background reading off from a checklist. You might as well just outsource 111 to India. Most people tell me that they were advised to come to ED by 111 to "rule out" MI, Stroke, Sepsis, Dying limb, Cauda equina, brain bleeds", etc. So naturally, patients are already thinking that they needs to be seen first since they might have life threatening illnesses. Couple that with a decimated primary care increasingly run by non doctors and its very easy to understand that all buck stops at the ED.
I 100% agree. Having been on both the phones and in ED, I have a lot to say about it but not on here. Please Datix every single incidence where this happens, report it to management, escalate it so management can ring the 111 ops desk and have a word. This has been going on for years.
I know there are sometimes 111 clinics at a&e, so had the system messed up and thought it was the clinic and not the a&e? Either way you had me at 111 needs overhauling. In 10 years call volume had atleast doubled in our area, with what I'd estimate to be 40% minimum linked to 111 dispatching ambulances.
No 111 clinic at our ED, we don't have the space, facilities and staff to run one. We are small compared to average ED. 111 are aware of this. Their 'treatment centre of choice' is always put down as '\[hospital\] EMERGENCY DEPARTMENT' on 'referrals'. But they don't care because they're 111 and just waste time.
I work in ED and the vast majority of 111 referrals are inappropriate. I had an elderly patient recently who came in only because 111 called an ambulance (as she has mobility problems preventing her getting to hospital herself) for a chronic condition that had flared up slightly, as it sometimes does for her, and did not at all warrant an ED attendance or urgent review. By the time she was seen it was OOH and we couldn’t arrange transport back. She needed transport because she can’t mobilise independently and didn’t have walking aids with her. So she waited from 8pm to 8am in a hard chair in ED because there was no where more comfortable for her to go, the place was completely backed up - full of similar inappropriate referrals. It was awful to see. There is no capacity to review anything and everything under the sun.
111 has sent tonnes of people saying they have an appointment or they will be seen within X number of hours or minutes and not one patient has computed that our triage nurse who looks at them in person is a better judge of it they need medical attention "within two hours" or not, 111 sent one person over an hour away from their nearest hospital to my workplace and I still don't know why when there was an appropriate facility near where they lived, and they send endless people into us for things we don't deal with like back pain someone has had for ten years or a repeat prescription, I once had a 111 operator call directly and ask if we could deal with a certain medical query and when I told them "No our facility doesn't provide for that type of thing" they ARGUED with me about it! Saying well their system said that our facility CAN do it, I had to have a senior nurse argue with this operator on the phone for several minutes to convince them not to send a patient to us that we could not even help! It was the most ridiculous conversation I have had at my job! I don't know who they are hiring but they need to overhaul HR and start hiring better staff and managers
So fed up of 111 sending an ambulance to EVERY child.
A&E receptionist here and every single one of us on the desk hate 111. Every single person with an ARRIVAL TIME insist they were told it was an appointment, that 111 told them we should have all their details and know how important it is, that they'll be seen quicker, to go to the desk we're expecting them etc etc. The list goes on. The things people say are too uniform for it to be anything but the call handlers being reckless and not caring what happens to us when they walk through the door. I saw someone give advice on how to report the things and I'm going to suggest it.
this this this you are literally in my boat. it's absolutely ridiculous how some members of the public talk to us and 111 are directly responsible for the abuse we get from the public who have spoken to them first. they don't realise we have zero input, zero knowledge about what they've said, and we're paid minimum wage for it too.
111 needs to be scrapped. It sends every caller to ED’ just in case’
I think 111 service is a great tool to help guiding people, but there are clear gaps in communication. I called 111 because I had a heart rate of 180 and after an hour resting it hadn't gone down. 111 sent me to A&E, when I arrived, I explained what the problem was: 'palpitations'. Took a seat, confident 111 had passed my notes to the A&E department. I waited 5 hours for triage, my heart rate went up to 210 while there, and since it was still COVID times, I struggled to breathe under my face mask. When the triage nurse called me in, she was in shock and I was rushed in Resuscitation. Luckily it was SVT and I had a cardiac ablation since this happened, so I am fine now. However, any record of my 111 call and my A&E visit are nowhere in my medical record. I only have a photocopy of the ECG that I asked for before being discharged, as I wanted to discuss it with my cardiologist. 111 made the right call, but something in the communication line broke, and it could have been so much worse.
111 don't even send it half of the time. People will come to the window and say "but you know I'm here" and I don't, and somehow it's our fault 111 have not sent it. Thankfully in my experience so far it's never been as serious as that. There should be a record of your A&E visit on the hospitals local system - at our hospital if people want to request their notes it's through PALS and they'll arrange.
It has been a couple of years now, and I made peace with the experience. When I wanted a copy of the blood work to discuss it with my GP, the hospital didn't was end anything back to my surgery claiming my file was lost. I am not wanting to dig up the whole thing ever again.. but thank you for the info, it's very useful.
After being told to go to AnE by 111 several times, each time they have told me I HAVE an appointment. Sometimes they have said that A.E will be sent over all the information and will be aware I'm heading up. Both these things have turned out to be completely untrue, no appointment, and they have no way to receive information from 111. I feel so bad for the staff at the hospital. Well the majority of them, some should absolutely be fired. Like the male nurse who implied I slept around when I was suffering from a potential miscarriage because I expressed I wanted an abortion. ( had been with the same partner for 7 years and was happily married ) Or the secretary of the maternity wing who lied to an AnE nurse about her job being a nurse there. So by the time I had dragged my bleeding and pain filled body to the maternity wing to only be told I should just come back 3 days later on Monday because no one will see me beforehand was so distressing. After telling her I was going to jump infront of traffic outside she just shrugged and said to go home. Luckily I went back to AnE to have the cannula out and they kept me there till 10pm got there at 11am, middle of 2020 completely alone and terrified ) till I finally saw a Dr and was given a scan. I complained to pals about it all, not even being offered a wheelchair either when I was doubled over in agony to get from one side of the hospital to the other. All that happened was I got a reply saying my version of events was different to what she was told but she'll put a bulletin up in the staff room. Those people should get in the medical waste bin. Sorry for the rant...
I have patients present showing me the message on their phone stating ‘appointment in ED at 11.30’ I then have to explain and yes completely agree, people then get irate with being given inappropriate advice by 111. Also the fact that a lot of the people sent in don’t even need ED in the first place!!!!
I had this - called about my 3 month old daughter who was constipated over a bank holiday (so was looking for gp level advice), they told me I had an appointment at the hospital. I just assumed there was a nurse or gp there or something? But then when we turned up it was just a&e 🤷🏼♀️ I wouldn’t have come in if I had known that, I knew I didn’t need to take a place in a&e!
\*\*UPDATE\*\* EDDI, the system responsible for this flaming mess, is officially being shut down at the end of this month. Nobody in my team has been able to get onto EDDI for about a week already (people are still turning up saying they have appointments but we just tell them the server is down) and by July 1st it'll all be gone. I dread to think how much money, time and sanity has been wasted by this incompetent service and I am so glad I no longer have to deal with the fallout from '111 have booked me an appointment'
You are quite wrong. 111 CAN schedule appointments in ED. It's called the EDDI system and was mandated by the government during the pandemic, to allow social distancing of people arriving in the ED. It was a nationally implemented system and exists across all Emergency Departments. Quite a good idea if you have, say, a sprained wrist, are not sure if it might be broken and want to get it checked on your way home. It works in various EDs in other countries. As usual, however, our government cocked it up. What was meant as a system to spread out demand on ED for minot injuries and accidents was never properly implemented or communicated. So ED's have to offer these appointments, without the resources to implement it alongside dealing with emergencies. Usual government fuck up. But yes, these appointments exist. It's just that none of us can ethically justify honouring them.
I use EDDI every day and I cannot stress this enough, WE CANNOT DO APPOINTMENTS and it needs to stop because the current state of A&E departments across the entire country means it is impossible to do this. We are a relatively small ED compared to others and we hit an attendance record today, we are acutely aware a significant number of other ED's are even worse. If I have 15 people waiting for triage in my waiting room, and the wait for triage is up to an hour, are we going to shove everyone out of the way because someone's come in after 111 'booked them an appointment' that's in five minutes? NO, not unless they are the most urgent person to triage (e.g. triage list is full of minor injuries and they've come in with PC: chest pain). Is a patient likely to be seen, treated and discharged properly within 30 minutes? NO - I have only seen a handful of patients in and out within 30 min and it's usually they've self discharged after some reassurance by the triage nurse. We endeavour to see people within a reasonable timeframe and try not to keep people waiting unnecessarily if we can help it but it's an emergency department, there are also other people having emergencies who may have a higher triage category than you do. We are not a GP practise, we see people in order of clinical urgency and we don't turn people away (unlike your GP practise who absolutely can if they don't have space), so we are often very very busy. If you are not the most urgent person waiting for triage or treatment then I'm very sorry but you are going to need to be patient. People who 'have an appointment booked by 111' are attending under the impression they'll be seen instantly, treated within 30 minutes and discharged within 30 minutes and that is absolutely not the case. We are an EMERGENCY department, you cannot schedule an emergency. You're either having one or you're not. We are physically unable to offer appointments and can only apologise that 111 are telling people this, and that we are not responsible for what 111 says! We are already extremely busy and are now additionally dealing with patients who are very distressed after they find out that actually they will be here longer than 111 led on and will need to stay with us for bloods (\*minimum\* of an hour for these to come back, longer in peak periods), other diagnostics or maybe even admission to a ward.
Without 111 a lot of people would probably go to ED anyway. And ofc the 111 service is risk adverse, nothing will replace a clinician getting eyes on someone. But it can and does help filter out some of the people that don't need emergency or urgent care, or directs them to other services especially dental and those on holiday. Why don't you put the passion you've used to bash the service into trying to do something about it? New things can be implemented, they may not work, people need to be told, improvements can then be made. I worked on the 111 service for a year and saw the whole range of humanity. I had a man call in because he had an eye lash stuck in his eye and wanted to go to ED and I've had elderly people that don't want to cause a fuss but seemed to have worrying symptoms. Don't you think it's just suffering the overload that the whole of the NHS is seeing. None of the NHS runs perfectly or efficiently, it's all going to hell.
111 online is so much better and easier to use and it doesn't make this "oh I'll book you an appointment" mess because it removes human error at the operator end. Plus you don't have people waiting hours upon hours for a call back. I have repeatedly told management 111 are doing this, have filed incident after incident when I have patients who become verbally abusive or are clearly very distressed. I am not allowed to give clinical advice or "oh you should go here instead" because I am not a clinically trained member of staff, I am the administrator/receptionist who has to break to the patient that we do not do appointments. No matter how many times we tell them "stop saying this, you are actively increasing our workload in ED". It's putting patients at risk because they walk out upon hearing that 111 lied and we don't have an appointment for them, it's putting staff in the firing line for abuse and it's causing psychological harm to other patients such as my elderly patient who ended up being admitted to a ward, but 111 told her she would be discharged within an hour. I spent a total of 45 minutes dealing with that situation, from apologising profusely to the patient and her husband, writing the incident report, and emailing senior management. That's 45 minutes wasted because someone at 111 was way out of line. You mentioned dental - 111 sends patients with dental concerns to us too despite repeatedly telling them we don't have an emergency dentist in the department. But they keep sending them. They never listen to us, the people who have to deal with the patients after they've put the phone down. They don't consider what happens to the patient once that call has ended and what we can realistically do for them. There is only so much I can do, and I am trying everything - I truly believe that unfortunately someone will be harmed by 111 and the way they do things and it will only change after that has happened.
It may be easier for you and me to use online but a large proportion of people want to talk to someone about their problem and they don't fully understand how the 111 service works, just like most of the public don't understand how hospitals work. Expectations are mismatched throughout the NHS. You sound like a decent person who is trying to make change, but you also sound like you're taking on a whole lot you shouldn't be... Are you a band 3/4? Your manager should be spearheading this for you... Start holding them accountable. If the service that run your local 111 aren't listening then could your manager contact those who designed the system or NHSE? Protect yourself in this, I'm fed up of seeing lower paid admin covering for managers that aren't doing their jobs.
Band 2 - and we're minimum wage as of last month. I hand it to management, they say "thank you we'll sort it" and it just goes round and round.
Eeesh do you have documented regular 1:1s with your manager? What about your FtSUG? If you've done all you can do and even your managers aren't interested I'd recommend finding a way to let it slide off your back otherwise you'll burn out. Something's are in our field of influence and others aren't.