Lesson from the failure of NHS Direct & 111: “Triaging should be done by the most experienced clinicians”

PULSE NHS 111 implodes as GPC withdraws support for urgent care hotline

The fundamental misconception politicians have about triaging is that for them it is a ‘bottom up’ process, non-medical unqualified people passing up problems to qualified professionals dependent on severity. The opposite is true however. Triaging should be done by the most experienced clinician and passed down the ‘chain’ according to expertise and experience. That would of course be unaffordable within current systems, which is why NHSD and 111 and whatever they will be replaced by in due course will be destined to fail

In the comments Dr Hubertus Von Blumenthal makes clear what anyone with experience of out of hour’s care knows. Triaging isn’t the easy bit where you can cut corners and save money.

It’s time for the Ministers who are seemingly obsessed with iPhone Apps (or is it Maps??) for Smartphones to begin to appreciate the much more accessible opportunities we already have:

> In the UK more than 80% of us have gone online in the last week

> Mobile phones have become the first consumer gadget to ever become as widely distributed as mankind and in rich countries like the UK there are more mobile subscriptions than citizens (making a mobile number a great way of identifying a patient – particularly if you’re offering informed telephone advice)

> The government would get unanimous support from mobile operators where it to ask them to make nhs.uk free to browse from a mobile browser (not least because it would be great for mobile internet discovery).

> There are clinically validated web based tools (like Instant Medical History – the interactive questionnaire tool we leverage as part of the documented consultations we offer at 3G Doctor) that can enable patients to document their own medical information so that experienced clinicians can make decisions on it and safely pass it “down the ‘chain’ according to expertise and experience” or indeed refer it on to the patients family Doctor (without the need to repeat everything or type it all up again).

> For patients who don’t have the ability to use these online tools the NHS could provide the 111 telephone service and because it won’t be chock full of patients (who could’ve used the internet to report their health concerns) these patients will have a much greater chance of getting their call answered.

If you think this isn’t something that the NHS could do check out the pioneering NHS work being done at the Haughton Thornley Medical Centres (part of the Tameside and Glossop Primary Care Trust) together with IMH UK and Wiggly-Amps (GP System Supplier).

Having used the Medical History Questionnaire process for the first time today, I am most impressed with it and found it very straightforward and comprehensive. I am keen to continue using this approach, which clearly provides tangible benefits to both the Patient and the General Practitioner. The system appears safe and secure in use and was very easy to access online. It delivers time saving benefits, which in turn frees up the GP’s time from basic data gathering, enabling the Doctor to spend the available consultation time delivering an enhanced quality of patient care. I highly recommend this system for wider roll-out” J Webster, Patient

Fantastic! I could not get such a detailed history in the 10 minutes I have to see the Patient. (The interactive questionnaire) Asks all the relevant questions and presents it in a quick easy to read format which can be part of your consultation… Brilliant” Dr Nadeem Ahmed, GP, Haughton Thornley Medical Centres

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8 Responses to Lesson from the failure of NHS Direct & 111: “Triaging should be done by the most experienced clinicians”

  1. I agree, the most important meeting in a patient-doctors relationship is the first encounter. Delay in diagnosis, wrong treatment or advice seldom occur in other countries because the senior experienced doctor (not telephone triage, nurses or junior doctors) will first make the“Clinically Diagnosis” before offering any treatment or advice.

    Only very experienced doctors can triage patients. As doctors are trained for almost ten years “Under Supervision” seldom make trivial mistakes and will help reduce complication or death.

    Junior doctor working in the hospitals see a patient in A&E or as a Gp Trainee in the surgery. They will discuss their finding with the registrar, consultants or the Gp Trainer. This 5 years training will help junior doctors learn and master diagnostic skills required to diagnose and mange patients in hospitals or the community.

    The problem started in the NHS since they used nurses as the front line staff (to help save money), mistakes occur and I have seen serious complications. NHS pandits claim the quality of care is brilliant but I have not found one publication that satisfy me the diagnostic skill and management of patient’s illness or disease is in par with doctors.

    The Nursing professionals have conducted studies and published data to prove “Patients are happy”. This does not prove the care offered is safe and the best quality in the world. I would call this “Licences Quackery”

    As a doctors, we spend all our life “Perfecting clinical skills” and avoid complications. Our duty is not to prescribe but to identify the cause of an illness and offer a solution.

    A nurse who sat with me for 12 days (ie., once a week) is allowed to work as a independent doctor in the NHS, so please tell me how can you expect these nurses to offer a service that you can trust and claim to be the “Best in the World”?

    The Manchester Protocol used for triaging was developed by using nurses and medical students observation. This system has not been properly authenticated and so pose great risk to patients and so people are loosing trust in their doctors.

  2. Pingback: NHS Direct website now offers landing page informing visitors to ring 111 if “you need medical help fast, but it’s not a 999 emergency” | mHealth Insight: the blog of 3G Doctor

  3. Pingback: What happens when you think triaging is the easy bit where you can cut corners and save money | mHealth Insight: the blog of 3G Doctor

  4. Pingback: If we used the tools of our time would returning out-of-hours responsibility to GPs still be ridiculous? | mHealth Insight: the blog of 3G Doctor

    • Certainly not, As a GP, I have worked for six months in OOH to check how my tools work. The number of wasted consultation is more than in the surgery because patients feel comfortable to speak through a telephone and they can say what they want.

      I have created a software that will help you to create your own tool so that you will not get calls from patients who don’t require any clinical examination. The software will do your job and so reduce calls by 30%.

      Once you gain confidence, I am sure you will figure out and reduce calls by 20%-30%. This will not reduce your income because you are offering the advice and treatment. I have tried using artificial intelligence but that can be a dangerous and not so personal. Here you know the patients and they trust your advice. This is the future, if we don’t some gig in USA will do it

  5. Pingback: “Patients should email GP rather than visit them” | mHealth Insight: the blog of 3G Doctor

    • I have better option than email. have created an app that could filter messages and produce auto response. The messages can be sent via smart phone and so save time and money. Please let me know if you are interested in trying. I will be happy to show you how it works

  6. Pingback: With 70% of UK Medical Students now female isn’t it obvious that the changed workforce needs more than just flexible working hour arrangements? | mHealth Insight: the blog of 3G Doctor

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