The affected person on the road was determined. ‘I need assistance,’ she sobbed. ‘I’ve tried every thing.’
I did my finest to reassure her, however as a name handler on the NHS 111 helpline – working undercover for the Each day Mail – I knew the truth.
Answering telephones at an NHS name centre in latest weeks, I steadily felt I used to be making issues worse not higher for exhausted, frightened sufferers – and that was a dreadful betrayal.
Lots of them had dialled 111 – the medical helpline for individuals who need assistance however aren’t sick sufficient to name 999 – as a result of they have been in ache.
I did my finest to reassure her, however as a name handler on the NHS 111 helpline – working undercover for the Each day Mail – I knew the truth
Usually they wanted pressing prescription painkillers however underneath 111’s guidelines I must ship them on a time-wasting merry-go-round earlier than they may get them.
Sooner or later, I answered the hotline to a person in his 50s who begged: ‘I’ve received again ache. It’s insufferable. I’m struggling, please assist me.’
He had beforehand been prescribed sturdy painkillers however his provides had run out. It was a weekend, and he was determined for extra.
The medicine he was searching for needed to be authorised by a physician. The affected person understandably thought I’d be capable of organise this sign-off for him. Sadly, he was mistaken.
One other caller, who was recovering from surgical procedure, informed me he wanted oxycodone painkillers, which was significantly troublesome. In lots of circumstances, a pharmacist can prescribe a drug as soon as they’ve checked a affected person’s document and seen that they’ve been given a sure drug previously.
Opioid painkillers, like oxycodone, are so-called ‘managed medicine’ whose distribution is rigorously regulated as they will result in dependancy. To prescribe these, a pharmacist has to get a physician’s approval – both from a neighborhood GP or one of many docs employed by NHS 111.
This causes issues. ‘Out of hours’ – within the evenings and at weekends – GP surgical procedures in lots of areas throughout the nation are shut. The burden of prescribing then falls on the docs at NHS 111. Throughout an eight-hour shift on a weekend, at the very least 4 of my calls have been often from sufferers making an attempt to get managed medicine. On a nasty day, it was maybe a 3rd of my calls.
Following the strict NHS protocols, I started to learn out a listing of native pharmacies closest to the caller’s handle, so he may converse to them and set the method in movement.
The caller interrupted angrily: ‘However I’ve already been despatched to a pharmacy, and so they’ve simply despatched me again to the 111 line! What’s occurring?’
Like all of the basic-level name handlers, I needed to comply with a script on display which informed me precisely what inquiries to ask. Although many calls have been from individuals searching for recommendation for a nasty chilly or Covid, the overwhelming majority have been about prescriptions.
Some calls have been from care properties the place aged residents desperately wanted painkillers akin to morphine to alleviate their struggling. As these are ‘managed medicine’, care properties are allowed to retailer solely a certain quantity. If somebody’s situation is worsening and their dose of morphine must be elevated, there is probably not sufficient out there to maintain them comfy.
A physician should log off a request for ‘managed medicine’, however I used to be not allowed to go carers, nor particular person sufferers who discovered themselves in related circumstances, on to a clinician employed by NHS 111.
NHS tips dictate {that a} pharmacist should make an evaluation, then contact an NHS 111 physician if wanted. However regardless of having a particular quantity to contact the docs, they steadily couldn’t get by.
So they might direct the affected person again to a name handler at NHS 111 – somebody like me.
Absurdly, underneath the strict steerage I needed to comply with, a caller needed to attempt two pharmacies after which come again to the hotline for the third time earlier than I used to be allowed to place them within the queue to get the sign-off.
It’s a surprising waste of time for everybody
One explicit case that shook me was taken by a colleague. A girl in her 80s, receiving end-of-life care, was left ‘screaming in ache’ due to delays in getting maintain of morphine.
The issue had seen two kinfolk and a nurse name 111. An error on her prescription meant the drug couldn’t be prescribed by the pharmacy, regardless of the affected person being ‘utterly bed-bound, combating for breath and in agony’, based on the decision notes.
This bolstered what the pharmacist informed me about her desperation to get morphine for a affected person of their 90s, who died simply days later: ‘It took 5 hours as a result of the preliminary name was referred to the pharmacy and never the clinician, who may have sorted it out inside half an hour. The affected person went three hours in extreme ache. He died a few days later and the household didn’t know in regards to the state of affairs.’
Till 2019, pressing prescription requests have been despatched straight to GPs. However NHS 111 guidelines modified to ship requests on to pharmacies – that are more and more overwhelmed.
Figures obtained by the Mail underneath a Freedom of Info request reveal that the variety of 111 referrals to pharmacies per yr has doubled since 2020, to greater than 515,000.
In our name centre, there was a system of 4 ‘surge’ ranges, exhibiting how stretched the service was, with degree 4 probably the most excessive; it was uncommon if we didn’t attain degree 4 by the tip of the day. On one weekend callers needed to wait as much as 35 minutes within the queue.
One of many pathway questions the pc system asks is whether or not the drug being requested ‘requires a prescriber’. This query is essential as a result of managed medicine may be deadly.
However since name handlers haven’t been medically educated, we have been instructed all the time to reply ‘undecided’ as a substitute of ‘sure’ or ‘no’ – this mechanically ends in the affected person being despatched to a pharmacy, relatively than the request instantly becoming a member of the clinician’s queue.
One pharmacist informed me: ‘The 111 helpline is an entire waste of everybody’s time. Of the eight referrals I’ve had at this time, they’ve all been inappropriate. The decision handlers simply ship all of them straight to the pharmacy by way of a referral after which we ship them again to the helpline. It’s actually surprising.’
