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Manchester Evening News
Manchester Evening News
National
Charlotte Dobson

From panicked parents to penis bumps - the mad pace of Greater Manchester's 111 health hotline

It’s 5.30pm on a Wednesday in the NHS 111 call centre and the phones are ringing non-stop.

A man has noticed a strange lump on his penis, and needs clinical advice.

He's been in pain for two months, but only calling 111 today, after a friend said he should get checked out.

A quick chat with the clinical advisor and the patient agrees he needs to visit an STI clinic.

It’s one of many sensitive queries the 111 call handlers, at their base in Horwich, Bolton field every day.

The pressure is always high - and although we spent the day with the team before the coronavirus outbreak, concerns about the spread of covid 19 have only added to the pressure.

A parent is waiting for a call back about their baby whose hands and feet have turned blue.

The little girl's dad has been at work all day, and at first he relays the information from the little girl’s nursery in a matter-of-fact way.

But as clinical advisor Carole Harvey asks more questions, the dad becomes more panicked.

While clinical advisors all follow the questions and prompts in front of them, their own clinical knowledge is invaluable.

The phones never stop ringing inside the NHS 111 call centre (Manchester Evening News)

"You have to have experience in this job," says Carole, a former paramedic.

"Everyone here has experience from different fields. They're used to dealing with people.

"You naturally adopt your rapport when you're speaking to people.

"If someone is telling you what's wrong with their child, you listen carefully to what they say.

"As a parent you usually know if there's something seriously wrong. You have to take that on board."

Carole pulls up a diagram of baby on screen as she talks through the symptoms with dad.

The diagram reveals prompts and questions for clinicians to ask callers as part of their assessment.

Carole seems puzzled until there's mention of a dirty nappy that was a much darker colour than usual.

It sounds like melena, a dark tarry stool, which can be a symptom of liver problems.

Carole Harvey was a paramedic for more than 30 years before she became a clinical advisor (Manchester Evening News)

As a clinical advisor, Carole isn't allowed to diagnose a patient.

But she advises the baby girl sees a doctor that evening.

"You can tell an awful lot from a bowel movement," she adds.

"Melena in a baby is very unusual."

The call is one of many from concerned parents that evening.

It’s the time of the day when kids are home from school, and their parents are home from work.

Typically the NHS 111 call centre will see a surge in calls in the evening.

Health advisors take the initial call and assess what each person needs using an online 'triage' system.

Some callers are simply unsure where to get the right treatment, particularly if they need help outside of GP opening hours.

Others with more serious queries, or young children, are handed over to a clinical team made up of experienced nurses and paramedics, like Carole.

If the patient is 'symptomatic' they are usually referred to an out of hours doctor or pharmacist.

Carole was a paramedic for 31 one years before she became a clinical advisor at NHS 111.

Parents of poorly children, people concerned about COVID-19, and mental health account for a great deal of the calls (Manchester Evening News)

One of the biggest challenges of the job is assessing a person over the phone rather than face-to-face.

"It's really quite a feat, telephone triage," says Carole, as she scans up and down the long list of patients waiting for call backs.

Another call is a dad who's concerned about his nine-year-old son's leg injury.

Carole runs through a list of questions to assess the pain, and they establish that the best option is to visit the nearest walk-in centre.

The next call is more concerning. A mum has been in touch about her five-month-old who has stopped feeding.

Carole runs through all of her symptoms and asks for the little girl's temperature.

It seems abnormally low at 32.8C but before anyone has a chance to panic, Carole has a suspicion the thermometer is faulty.

A reading of the parent's similarly low temperature confirms she's right.

Carole deems the little girl 'generally unwell' and not seriously ill. The mum is advised to take her baby to a GP as soon as possible.

Carole’s colleague, Emma McLaughlin, is a former A&E nurse turned clinical advisor at NHS 111 who is dealing with some of the lower urgency calls.

She calls a mum with a query about a rash on the bottom of her 11-year-old son's foot.

A pharmacist has told her it could be hand, foot and mouth but Emma isn't convinced.

She pulls up pictures of hand, foot and mouth disease on the NHS website as she chats to the mum about when her own children had the infection.

"A lot of things you know from having your own children," says Emma.

"Rashes are really difficult for parents and they do cause a lot of panic because of the septicaemia link."

Emma follows a different triage pathway to Carole, using one similar to those used in A&E.

It looks like a complicated set of coloured boxes and diagrams, yet Emma navigates the questions quickly with callers.

Health advisor John Paterson having a brief pause in between calls (Manchester Evening News)

Emma feels it’s important not to rush patients.

"You want them to feel comfortable," she says.

"I would never want anyone to feel rushed.

"A lot of the calls are really sensitive."

A lot of call-handler's time is spent either helping people get an out of hours appointment with a GP, or finding the right service near them.

There are the hypochondriacs who call regularly too.

"Oh yes, you can spot them a mile off on the list," says one call-handler.

It’s not an easy job, even for experienced clinicians like Emma and Carole.

Clinical advisors are regularly audited at NHS 111, and if there's a complaint their call will be scrutinised.

Such scrutiny can be tough for nurses and paramedics with high levels of expertise.

"It is a profession where you have that type of reflection," says Carole.

"I have learned to accept that it makes me a better clinician."

Read more of today's stories here

Like most NHS services, the biggest challenge is dealing with the high level of demand.

John Paterson is a health advisor and answers calls as they come in - like his colleagues, a good number of those he deals with are from anxious parents.

Mobile phones are not allowed on their desk, and there's no time for chatting between calls.

"When you are on the phone, you've got to keep things moving," he says.

"There are 60 callers in the queue, you have to keep it rolling."

Marty Blackhall is one of the service performance managers on duty.

He says the system is under constant pressure.

The service also has to continually update its advice in line with national guidance.

Posters with guidance on Coronavirus are dotted around the office.

And Marty says queries about COVID-19 and mental health calls often dominate the phone lines.

"Winter pressures don’t exist anymore", he says.

"These days the pressure is on all year round.

"The sheer volume of calls is the biggest challenge we face."

More information about the NHS 111 service can be found here.

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