Challenges of an NHS 111 call handler

By Laura Tweedy 29 August 2018

Laura Tweedy picture

When I was asked to write a blog on the challenges that 111 call handlers face I was delighted. Having just left the NHS 111 service provided by North East Ambulance Service (after 10 long years!) I was keen to talk about my time in this valuable service.

When I first started thinking about some of the challenges 111 call handlers face the first one that came to mind was the lack of public understanding. Most people think they can just pick up their phone, go through a few questions and get the help they want… wrong. Triaging someone’s symptoms, without being able to see them, is a complex task. To direct a patient to the most appropriate care it’s often necessary to ask quite a lot of questions.

Answering a 111 call is a process of picture building. Each question you ask adds another little bit to the jigsaw – and sometimes the jigsaw can be very complicated. After a triage of the patients’ symptoms has reached an outcome, the system searches the Directory of Services (DOS). The DOS displays a list of services that can deal with the patients’ symptoms – for example, urgent care centres, pharmacies or emergency dentists. The services in the DOS are chosen and prioritised by the commissioners in that area. So, an underused service may display first even if it’s further away from the patient. And, if a patient/caller doesn’t get offered what they want, when they want it, there can be conflict when trying to deliver the appropriate outcome.

Answering NHS 111 calls can be stressful at busy periods, like weekends/bank holidays.  You’re at work at a time when, let’s be honest, you’d rather be elsewhere and the demand of calls in these periods is high. Getting hold of clinical help can be difficult. Sometimes it’s difficult to get hold of someone and you end up having to place the call in the clinician queue. This can be frustrating when you know that, if you could speak to someone, the call could be easily dealt with.

There is also a lot of pressure on the 999 service – and this is something that is always in the back of your mind when you reach an ambulance outcome. The ambulance responses are monitored and, if you have any sent any ‘unnecessarily’, this is fed back and any training issues identified.

There is also a lot of information to remember. The NHS Pathways system we use is great. But, there are always local procedures and ‘work arounds’ to use as well. Sometimes the DOS doesn’t quite profile in the correct order and we’re expected just to know that. An example of this would be a patient who lives in North Tyneside and the services profiled are near in distance ‘as the crow flies’ but not by road. So, the system may present an urgent care centre in South Tyneside. This is because it won’t have taken into account that the River Tyne separates the two areas and to drive there would involve a longer distance.

It can be difficult that there is also a lot of negativity in the news/social media around NHS 111. You almost feel like the job you’re doing is a bad one. You’re always hearing the bad stories and there is little focus on the good stories – and, believe me, they do exist!

Being an NHS 111 call handler, you can face some challenges. However, it’s a very rewarding job and that makes it all worthwhile. It’s lovely to be able to take a call and triage it trough to an end-point all in one call. The fact someone can ring at midnight on a Friday night – and get an appointment within a few hours at a local urgent care centre, if needed – is a fantastic service. And it’s one that all call handlers are proud to provide.

Laura Tweedy is Organisational Development Learning Training Officer for NHS Pathways at NHS Digital.