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At the heart of general practice since 1960

More NHS 111 stupidity

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I know that the words ‘shooting’, ‘fish’ and ‘barrel’ spring to mind when criticising those lovely NHS 111 Pathways Reports. But, just when you think you’ve reached the absolute pinnacle of f***wittery – in my personal experience, a man who had noticed that, on stretching his rib cage, he experienced a twinge in his sternum, and ummed and ahhed for eight weeks before phoning our favourite 24/7 healthcare helpline, at which point the words ‘chest’ and ache’ bypassed all logic and common sense, rang reflex, protocol-driven alarm bells and resulted in a bewildered-looking patient being corralled into an emergency appointment with an annoyed-looking Dr Copperfield – it manages to completely and utterly surpass itself.

Specifically, we receive an NHS 111 report giving a patient with unscheduled vaginal bleeding – who, for the avoidance of doubt, is not pregnant, collapsed, on fire, etc - the following advice:

‘Contact your GP practice during normal surgery hours’ (good) and ‘Keep any towels etc that were used to mop up the blood - they will need to be checked’ (bad) and furthermore, ‘If bleeding becomes heavy and you start passing clots, save everything passed in case it needs to be checked’ (really bad, especially if they phoned right at the beginning of a bank holiday weekend).

And if that’s the advice with vaginal bleeding then, for infant gastroenteritis it’s bound to involve used nappies, for adult vomiting a bucket, and in cases of haematospermia, well, frankly, I don’t even want to think about it. I just pray that this particular NHS 111 pathway does not end with the last appointment before lunch.  

Dr Tony Copperfield is a GP in Essex. You can email him at tonycopperfield@hotmail.com and follow him on Twitter @DocCopperfield. 

Readers' comments (16)

  • The 111 people in your area must be the cream - on my patch chest+pain=A/E by blue flashing light!

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  • Patient report to NHSD included the information that he had had to walk to the end of the pier (an obvious local feature you can't miss, and I could find easily) to get a signal on his mobile phone to call NHSD.
    Comment from NHSD that they had advised patient to return home (and made a mistake in identifying the address, so it was very hard to find) and await a phone call from the GP.
    Unfortunately, perhaps, assuming it would take me some time to respond, whereas in fact I responded immediately, but the patient was at that time making progress home from the pier, but had not arrived there until sometime later, and, of course, I could not phone him along the way, as we had already identified (?) that there was a lack of phone signal anywhere other than on the pier. But I coukld not phone NHSD from the patient's home to report concern at his absence either, as I would have had to go to the pier to get a mobile phone signal.
    Our local GP phone answering service therefore uses landlines most of the time, unlike those modern people at NHSD!
    DC

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  • Just wait. They have had a significant event investigation on a contact on a fit 48 y old phoned up with a sore throat at just before 8 am told see GP who saw 10-30 am , dicovered to have no BP and dead of speticaemia by 5pm despite immediate hospital admission.
    Blue light AED for all sore thorats next month?

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  • Interesting...... One of my patients who WAS in the early stages of pregnancy and woke at 2am with severe RIF pain and bleeding that was the colour of "prune juice" was simply told that she needed to speak to a GP within 2 hours. Because there was no real sense of urgency communicated to the patient she thought she was okay waiting until surgery opened at 8am, when she called me. The lengthy tome I received was the usual rubbish and had probably taken 15 minutes on the phone. Within 1 minute without using a flow chart or script I advised her that she had symptoms suggestive of an ectopic and advised she attend AED immediately. I do not yet know if this was an ectopic or not but the fact is, it could have been and the advice from 111 was potentially life threatening for this patient.

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  • Abdul QADRI

    Dr Chaand Nagpaul, NHS has been bombarded with too many changes by successive Governments. These changes have been made just to please innocent voters. Why do you need all these outside unregulated so called medical advisors to run out of hours service. Those of us who have worked as single handed practitioners since the beginning of 1980's didn't have any problem whatsoever to provide such a service. Patient knew who they were talking to and that in itself was reassuring to them. At the time, I used to take my own calls at night and my patients would rarely disturb me for non urgent or irrelevant problems during night time. I didn't mind at all to take my own calls as I was young , vibrant and full of energy to make my contribution in the over all care of my patients. After say the age of 50 years one can understand the difficulties you can face to cover the patient care during out of hours. Nowadays it is not a big deal as most of the practices are in partnerships of two or more doctors. They can easily provide a cover on rota basis like everybody else in the secondary sector. There will be no confusion and all the patients records will be under one umbrella and trust me our patients will appreciate that. Come on in your early 30's to 50's you have got be part of this care and will have more satisfaction of having chosen to be a primary care Doctor or in old terminology Family Doctor. I am sure all this debate GP representatives and the Govt is waste of time and will achieve nothing except some emergence of another out of hours service like magic 111?
    I am sure that my colleagues might say : yes yet another observation from an old retired GP who is out of touch with the current challengues. I disagree with that as after working for 32 years as a GP , there hasn't been a single occasion when I had to face any disciplinary body like Family practitioner heads, Pct's or GMC and that itself is an example of self governance.

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  • Yes, yes..heard it all before. Even wrote an article in The Doctor years ago about NHS24 and similar problems.
    Nothing changes, only the names.

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  • Abdul ,
    your comment obviously shows a complete lack of understanding of current OOH framework and the national guidelines which trhe must obey by.
    If you think you can do OOH today in the same way you did 30 yrs ago writing a few notes on a scrap piece of paper and tunring up at someone's home whenever you fet like it , you are dead wrong. Im not suggesting the system is better, but that demand and expectation is different .
    In regards to never having an investigation , well congratulation , however this might only be an indication that monitoring in your days was extermely poor in comparaison..
    And finally yes we think it is again a bias view of a person who in retirement will not be affected by any nonsense he's suggesting..

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  • Abdul you are in a moinoriy of 1 (I think)
    I work damn hard as a GP during the week 50 plus hrs and I intend to keep my evenings and weekends free including family time playing Golf sat and sunday
    this work life balance keeps me sane and fit
    i have been around 30 years as GP and via rotas etc
    have done very minimal OOH from the start. I thoroughlly enjoy my in hours work knowing that i can switch off
    I have not had any complaints or gmc hearings etc either so your arguement is naff and yes another observation from an old retired GP- on that you are probably correct

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  • as a clinical director for a 111 provider covering a population in excess of 5million and a GP of 38 yrs I find most of the above ill informed and opinionated. Can any GP hand on heart say that there have been no occasions when their receptionists have made errors of judgement or refused patients appointments. We take in excess of 5,500 calls on a saturday and, guess what, occasionally we get it wrong. When we do, we do end to end reviews and,if needed, a RCA not something that is routinely done in General Practice. In the 8 months that we have been running patient compliments exceed complaints. What would improve the OOH service is 1)explicit Special Patient Notes with detailed individual care plans and 2) access to being able to book telephone consultations with in hours providers. So lets stop knocking each other and start working together for benefit of our patients.

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  • Abdul QADRI

    Had I known that I will get such response from my Anonymous colleagues? I would have never commented on the proposed shut down of NHS 111. One of my Anonymous colleague comments: I lack understanding of current OOH framework and the national guidelines. Let me remind my friend that I have just retired on 31st of March this year and understand it very well. I was giving my personal views about the way a single handed GP used to communicate with his patients almost 24 hours a day. Let me add here that we used to arrange even a Pharmacist for the patient to deliver the emergency medicine if needed. The system worked very well for me and I am not suggesting that it would in the current environment. Yes I agree that patients have different expectations now and it is the successive Governments who have made health care as a political game. They keep on changing the system and come up with different ideas and talk big things on the media to please the voters. I have gone through Coop ,to QOF etc and as soon one gets used to the system and GP’s meet their targets and make claims for the hard work, Government makes changes in the QOF and sets up higher almost impossible targets just to penalize GP for achieving the previous targets. We were responsible for our own monitoring and I hold the view that with less interference by the Government, it worked very well. I am proud and satisfied with my achievements. I started with 35 patients and my first salary was £70 a month. I had to work at nights for nearly 1 year to make two ends meet. Let me tell you something my friend that within 6 months 500 patients registered with me and rest is a history. When I retired on 31.03.2013, my list was just under 2400 and that itself is the best appraisal for my hard work. In your last sentence, you commented that my suggestions are nothing but nonsense. I find that comment unnecessary because Government is not going to make changes after looking into my comments. After all I am an old 62 year old retired guy.
    2nd Anonymous Colleague of mine says that I am in the minority of 1. Let me make him happier by saying that I don’t count in your calculations—Remember I have retired on 31st of March this year. He says he works very hard for > than 50 hours a week and has been GP for over 30 years and wants to keep his weekends free to enjoy himself. My friend that is exactly what I commented that after the age of 50 years, one has to delegate work to the juniors as you have worked damn hard. Congratulations that you had no gmc hearings after long years in GP and at least we have one thing in common. To conclude your comments like this: My argument is naff and yes another observation from an old retired GP-is rather unnecessarily. Correct me you might be even older than me and if so I respect your observation too and today I am 62 years old retired GP, tomorrow you will also join my club.
    In summary I am afraid like our Government Doctors are preoccupied with entering all kind of data in their computers and have hardly any time for the patients. I am entitled to my view: This is the main reason why our patients are abusing the OOH services as they are not satisfied in the care they receive at their own Doctors surgeries( NO FAULT OF DOCTORS AS IT IS THE COMPUTERS THAT SUCKS YOUR TIME) WHO TO BLAME THAT IS AN OPEN QUESTION?

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From: Copperfield

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