NHS has many out-of-hours services

Shelley Noble, clinician call handler for NHS 111

Shelley Noble, clinician call handler for NHS 111

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From aches and pains, to advice on medicine, poorly babies, and chest pains, the NHS 111 service fields a wide variety of calls.

Run by South Central Ambulance Service (Scas) in Hampshire, the free phone number was started in January last year.

The number is free to call, and is available 24 hours a day, 365 days a year.

Trained call handlers speak to those who phone, and use a triage system to see how a patient may need help.

The centre that responds to calls from the Portsmouth area is based in Otterbourne.

Jessica Tucker has been working as a call handler with Scas since October last year.

She said: ‘It is hard, as you have all sorts of members of the public call in.

‘You get everything from headaches, to wound problems, sexual health problems, and many others – there’s a wide spectrum.

‘Most people accept what we tell them.

‘They will listen to our advice and the information we give them.

‘I think for others it’s a service people will need to get used to.

‘Some people use us more than others, and others don’t understand what we do.

‘If people are short or rude with us, then it’s probably because they are in pain, or speaking on behalf of someone else who is.

‘When I first started I was a bit nervous, but the training given does give a lot of guidance, help and support.’

In an average week, 9,000 calls are made to the service.

And half of those calls are made at the weekends.

The idea behind 111 is to be the number to centralise help available after hours.

People can call to get access to dental help and the out-of-hours doctors service.

Mark Rowell, head of the NHS 111 service, said: ‘When people call 111, which is a free number, they come through to a call handler.

‘The caller will always ask for your name, age, address and sex.

‘It’s a national requirement that we can identify a patient, as this way we can let their GP they called us.

‘It helps us see whether people are calling us for help managing long-term conditions, and who repeatedly calls us.

‘After that, the patient is asked a series of questions to see what is wrong and what kind of help would be appropriate.

‘This could be advice over the phone, to go to a walk-in centre, visit a pharmacy, see their own GP, and out-of-hours doctor will contact, or go to A&E.

‘We can also dispatch an ambulance while we are still on the phone to a patient, so they do not need to redial 999.’

The triage tool used is called Pathways, and has been devised by a GP.

Patients can also ask to speak to clinicians, who are also available to help.

Shelley Noble is a trained nurse, who works for 111.

While The News visited, a call handler referred a patient to Ms Noble.

She said: ‘This call was from the mother of a nine-month-old baby from Southsea, who was worried her child had symptoms of meningitis.

‘Both the caller and the call handler thought it was best 
a clinician gave advise as well.

‘So I checked the details the mother had given to the call handler, and made an assessment that it didn’t seem to be meningitis.

‘But while talking, I sent an ambulance, because I felt a pair of eyes needed to see the baby to be sure.

‘I sent the ambulance while I was still talking to the mother, so that didn’t hold up help getting to them.’

On average, Scas said that a call handler will be on the phone with a patient for about nine minutes, while a clinician will spend about 13 minutes.

About 21 per cent of calls made are triaged by clinicians.

There is usually one clinician to five call handlers.

The number on duty can vary, depending on the level of demand.

Mr Rowell said: ‘During the day we have about eight or nine call handlers.

‘This goes up to 24 in the evenings, and then back down to 10 after 11pm.

‘Saturday mornings are extremely busy for us, and we have 42 call handlers on.

‘By 11am it’s not unusual for us to have taken 900 calls.

‘On a Saturday morning we can take about 240 calls in an hour.

‘A lot of them are for prescriptions, and things they should be going to a GP for.’

Scas signed a £20m contract in October 2012, to deliver the service for five years.

NHS 111 is paid for by the clinical commissioning groups.

The Hampshire Doctors on Call Service is provided by Portsmouth Health Limited, which sub-contracts the management and delivery of the service to Care UK.

HDOCS provide advice, information and treatment for patients who become unwell during the out-of-hours period when their own GP surgery is closed.

The service runs Monday to Friday from 6.30pm to 8am, and 24 hours at weekends and during Bank Holidays.

You can access the service via the NHS 111 number.

An out-of-hours doctor will be able to do these things:

n Give advice and guidance on how to deal with symptoms at home.

n Arrange a face-to-face appointment to attend a primary care centre to see a doctor. In this area, these centres are in the Gosport War Memorial Hospital, and Queen Alexandra Hospital.

n Arrange a home visit from one of the doctors.

There are about 180 GPs signed up to the service, with 90 per cent sourced locally.

Locum doctors are used to help out at peak times.

Care UK said that GPs who work on a flexible basis are paid between £48 and £85.

HDOCS started the service in October 2012, and in its first year of operation saw more than 78,000 patients from the Portsmouth area.

PHARMACIES can help with a range of common conditions and minor injuries, including aches and pains, colds and skin rashes, and some contraception.

For these ailments, patients can also speak to a pharmacist, instead of seeing their GP.

Dr Alastair Bateman, a GP partner at Stakes Lodge Surgery, in Waterlooville, said: ‘Pharmacies are a huge asset to the community.

‘Most people appreciate pharmacists are experts on medicines, so can help you with any query you have, and also dispose of unused medicines.

‘But they do so much more than that. They are a great source of help for minor ailments and health conditions.

‘They can offer a wide range of advice on helping us lead healthy lifestyles, which can be anything from stopping smoking support to promoting flu vaccination and advice on diet and exercise.

‘They also signpost patients to other healthcare providers or NHS services, and have a role to play to offering people advice on how best to care for themselves or their families.

‘The Clinical Commissioning Groups remain concerned people are going to the emergency department at Queen Alexandra Hospital in situations which are not emergencies.

‘This is slowing down the system for those people who most need it.’

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