Fiona Quayle (above) and Chelsea Small both work for London’s NHS 111 provider Practice Plus Group. A qualified nurse, Fiona is a clinical advisor for the service. Health advisor Chelsea is also a coach and trainer for other team members.
Fiona Quayle – NHS 111 clinical advisor
Fiona Quayle has had a varied career in nursing, working with everyone from babies to stroke patients – and in emergency departments, where she loved the fast pace and ability to get results. Now a clinical advisor for NHS 111 provider Practice Plus Group, she picks up the more complex cases which can’t be instantly solved by a call handler.
Tell us about your role
As a clinician, I take calls from people who have already been assessed by our health advisors. I take a little history, being alert to any red flags. I may offer them help or refer them to another service. It is 100% a privilege to take these calls – getting people to the right place to solve their issues.
What are the options for the people you help?
If it’s safe to do so, we’ll give home management advice. If it’s something that can safely wait, we may book them an appointment with a GP or ask them to call their practice in a couple of days if symptoms are still there. If it’s more urgent, there are out of hours GPs and if you have an elderly person, for example, there’s the two-hour urgent response. There is also the option of the emergency department or an ambulance. But you’ve got so many options to prevent people going to hospital if they don’t need to be there.
Which calls will come through to you?
People with a complicated medical history or one that may be pertinent to the current problem. They may need medication advice, or they may be a palliative care patient. Sometimes they are struggling to prioritise their main symptom.
What’s a typical day like?
You sit down at the start of your shift and take your first call. All your prep goes on beforehand, and then it’s calls, interrupted sporadically if a health advisor needs my input. I take cases in order set by the people overseeing the system in real-time. Calls are prioritised according to risk. There’s a colour code with usually the most critical first.
How does your role change in winter?
Winter will add on probably another 100 callers to the queue each day, possibly 200. A large portion of the calls will be the coughs, colds and flu that may seem to be low risk. But what seems at face value to be simple may be so much more, especially with the very old or the very young.
What do you like best about your role?
I’m one of those people who really functions well on high pressure. I was an emergency department nurse and it just suits me. I can make things happen; help people, by giving advice on managing their symptoms and moving their case forward. And I love speaking to people.
What’s been your journey?
Originally, I wanted to be an artist. Then I wanted to be a nurse. I did my training then went off to look after intensive care babies, but that wasn’t for me and I went back into general medicine. I did a neuro course and worked with stroke patients. Then I started working in an emergency department, because they needed a hand, and stayed for many years. I absolutely loved it.
When you’ve got a sound grounding in general medicine, you can deal with most things – you really know how the body works and how it will respond to treatment. I can’t believe how I fit my current role – and how this role fits me. I worried I’d done too many things – jack of all trades – but my experience has come into its own in this job.
Tell us about a patient you’ve helped?
A caller phoned up for her mother. The patient had worsening confusion and generally didn’t feel very well. I was able to rule out any life-threatening problem. During the call, a carer came in and was concerned that the lady was incontinent, which wasn’t usual for her, so it became apparent this was a urinary tract infection. Because of her age, medical history and that she was living on her own we were able to arrange a GP visit within two hours.
Chelsea Small – NHS 111 health advisor
Tell us what a typical day is like
I come in, log on, check my emails, check my schedule and get ready to take calls. As a health advisor I can take any type of calls ranging from non-urgent issues right up to emergencies. I also coach trainee health advisors. I introduce myself, discuss what we are going to do today and prepare them to listen or take calls.
What do you like most about your job?
I love helping people – knowing that I have helped someone’s loved one, family or friend feels really rewarding.
What are the challenges, especially in winter?
Any time of the year can be busy, but in the winter, we have the typical cold and flu symptoms. In more recent times, Covid-19 has made people more cautious about symptoms and worried enough to call 111.
Sometimes our clinical queues can be in the hundreds. Although these queues are watched and prioritised, we get patients calling back because they are frustrated and angry. Sometimes it’s challenging reassuring patient and explaining that all services are under pressure.
Is there one thing people can do to get the most from the NHS 111 service?
Trust our pathway system, which really does get people the right care and understand that we may encounter delays. Also please make use of other services such as local pharmacies.