Sunday, 30 March 2014

Isn't 111 shite?

I did the right thing today. My boy has had a bout of croup, it started Thursday evening. He gets medication to deal with it as it has been a chronic condition for five years now. The medication dealt with the croup, but he was left with a nasty hacking cough and his respiration rate was really high. By today, Sunday it didn't seem to be self-resolving as it has in the past and we figured it needed the once over from a GP.

It's Sunday so we ring the new 111 service which is now the prescribed advice. After you have navigated the menu system which seems to have been recorded in a station concourse you are though to a call handler.

Explaining the problem doesn't help and saying "any chance we could get a GP appointment so someone can listen to his chest and see if it's clear." will not give you the outcome you need. I went though maybe 20 questions over 10 minutes before I got booked into the system.

I assume the call handler had access to the boys notes but was sufficiently unskilled to be allowed to interpret them? Otherwise it's a no-brainer - look at his history, he needed to be seen. A GP from the out of hours service rang back in 10 minutes and then all was grand we git an appointment. The boy is now sloshing down the Amoxicillin and he will be right in a day or two. Thing is next time I might as well just take him straightdown to A and E which is definitely not the effect the NHS is hoping for with the 111 system. But he will be seen by a qualified health professional straight away, They will refer to out of hours if appropriate and I will get a quicker outcome.

If we can't provide a Healthcare system where the first contact is with someone who can make meaningful judgements rather than merely read a script I suspect people will keep going to where they know they will be dealt with most effectively. Even if those attendances are putting pressure on services that exist to deal with profoundly poorly people. Why are we paying a GP Locum rates to sit in an empty Hospital when the GP surgeries are closed so the partners can have weekends off when few others in urgent care get such a favourable shift pattern?

Bottom line is GP surgeries need to work 7 days a  week and offer some cover overnight. If that is they actually believe in local services for local patients. They need to put our money where their mouth is. It's hard to believe that 111 is an optimal service as it's currently configured. I'm not suggesting your first point of contact needs to be a face to face contact with a GP. The tele-diagnosis model has some merit if backed up with access to a patients notes and there are a range of Specialist Nurse prescribers that a currently under-utilised locally. Arguing that we just don't do weekends isn't good enough anymore, the world has moved on.


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