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111 won't work - 'non-emergency' is simply not in our patients' vocabulary

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‘My little Princess has just been sick. Of course it’s an emergency.’ And there, in a raving dickhead nutshell, is the reason why the NHS 111 service is doomed.

Granted, a quartet of McNuggets, a dozen French fries and most of a Snickers McFlurry had just ‘emerged’ from Princess’s innards but that doesn’t actually qualify it as an ‘emerg-gency’. Not in the more widely accepted use of the word emergency to mean, ‘something not resulting from force feeding a toddler too much junk food.’

‘If you need medical help fast, but it’s not life threatening, you can now call the new NHS number – 111,’ says the information leaflet, promoting the new single point of access telephone line.

This all sounds very familiar. A quick dig through the archive found an article I wrote fourteen years ago after the NHS announced its new single point of access non-emergency number, ‘888’. This may have failed because ‘888’ was in fact the dialling code for Stoke Newington and obsessional patients might have found themselves discussing their compulsive symptoms with Stavros and the rest of the staff at the Manor Road Kebab House on 888 8888, rather than the specially trained triage team.

Besides, whatever happened to NHS Direct? I’ve searched high and low and have been completely unable to find a single anecdote from a GP or hospital doctor complaining about the quality of their triage service. Their specially trained nurses, aided by the NHS’s state of the art IT systems, appeared to be nigh on infallible when it comes to over-the-phone diagnosis, assessment of urgency and accurate signposting to appropriate care. Perhaps the problem was that their contact number 0845 46 47 was one tantalising digit longer than most peoples memory can cope with.

Ambulances from our local station are decorated with posters showing, for example, a bloke trapped under an overturned lorry or a little old lady who is so ill that she’s got an oxygen mask on and more worryingly, seems to have been separated from her handbag. ‘THIS is an emergency – call 999!’ Yeah… we kinda got that. The bloke’s arm lying two or three feet away from the rest of him was a bit of a giveaway.

Ask any surgeon what constitutes a ‘minor operation’ and you’ll get a reply along the lines of, ‘a procedure performed by someone else, on someone else.’ Ask any punter on the High Road what constitutes a ‘non-emergency’ and he’ll reply, ‘Someone else being ill.’

He pays his stamp, he knows his rights, he’s seen Dr Hilary on the telly. He’s not going to arse about with some specially trained call handler, supervised by a specially trained nurse, backed up by a specially trained doctor freshly arrived from Palermo on Ryanair. He’s going to see a proper doctor first off, even if that means dialling 999.

There’s a phenomenon called ‘ostalgia’ – the hankering that people born and raised in East Germany under communist rule have for the old days before unification. It may have been crap back then, but things were simpler. If you wanted bread you went to your nearest identikit bakery and joined the queue to buy an identikit loaf from an identikit Stasi operative dressed as a baker.

I’m starting to feel the same way about the NHS. When you were ill in older and less enlightened times you went to your GP if the surgery was open and held on till morning if it wasn’t. If you didn’t think you were going to make it through the night you got yourself to A&E.

If you were right you got the best care the NHS could offer. If you were wrong you spent long hours waiting to be seen as Matron made sure the really sick ones got priority. Sometimes they even sat you under a sign reading ‘Minor Cases and Trivia’.

And after a couple of long cold nights in the waiting area, with no TV, no drinks machine, no infomercials sponsored by ambulance chasers and shyster lawyers, you’d realise that spraining an ankle or having a sore throat was part of life rather than the end of the world and you’d learn how to look after it yourself.

But now? Do you self care, ask your pharmacist for advice, Google your symptoms, use the NHS online symptom checker, ring NHS Direct, call 111, 112 or 999? Do you ring your GP’s out of hours service? Or do you sit there paralysed by choice for a while before heading off to A&E to see a doctor?

Dr Tony Copperfield is a GP in Essex

Readers' comments (1)

  • Mothers actually tend to be experts on when their children are seriously ill, and too many medical horror stories begin with the doctor saying 'you're just a worried Mum'. But clearly this new system requires that patients themselves, rather than specially trained staff, be able to make a diagnosis to distinguish an 'emergency' from an 'urgent' medical problem. Until we've had the training, don't expect us to do this accurately. Actually, before NHS Direct, it was usually the receptionist who could tell us whether the symptoms were of 'something that's just going around right now' or did require the doctor's attention.

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From: Copperfield

Dr Tony Copperfield is a jobbing GP in Essex with more than a few chips on his shoulder