Natalie Randall is one of NHS 111’s clinical advisors who can provide expert advice (Image: NHS/Getty)
Stomach pains, fevers and unexplained rashes are all in a day’s work for an NHS 111 health advisor. But a call about a squirrel bite was something a little out of the ordinary. The query, following a park encounter with a bushy-tailed assailant, is among the more unusual cases Jack Gibson, 34, has dealt with. “We would have triaged the bite and then given advice for covering and cleaning the wound,” he says.
“I imagine we probably sent them to hospital for the wound to get reviewed, and then to get a tetanus injection.” Jack, of Devon, started working for the health service’s free, 24/7 medical advice helpline almost three years ago. The role offered the opportunity to work more closely with patients than his previous job as an NHS auditor. Other memorable calls include a person bitten by a cat in Morocco who needed rabies injections, a child with tummy ache later revealed to be the result of a sibling jumping on their belly, and an array of youngsters with foreign objects stuck in places that they do not belong.
Despite the variety of calls, Jack is not medically trained. Instead, he spent a month in the classroom learning how to use NHS Pathways — the clinical triage software that assesses a patient’s symptoms by systematically ruling out the most dangerous potential causes first, before directing them to the right medical care. Local training and coaching then allowed Jack to begin taking calls from real patients.
The training taught him the vital basics like recognising the symptoms of a heart attack, stroke, or sepsis. It also helps him know when to contact the clinical advice line for advice from a healthcare professional.
Answering his first call was extremely nerve-wracking, Jack remembers. “I was overthinking every call. Now I’ve probably taken over 10,000 of them. I used to do six-hour shifts and, if we were busy, I could take up to 35 calls.”
He has also come to understand the rhythms of public health. “Weather’s a big factor, when people are happy and out in the sun. There’s definitely seasonal variation. Christmas Day tends to go really quiet, but then other days around Christmas can be really busy.”
The NHS began piloting 111 in 2010 and the service triaged 277,000 calls in its first year of operation, when it covered a population of 1.8 million. It is now available across Great Britain. England’s service handled almost 20 million calls over the last 12 months.
Call handlers can offer self-care advice at home; book an appointment with an out-of-hours GP; refer patients to pharmacies, urgent care centres, mental health services or A&E; or dispatch ambulances.
The goal, Jack explains, is to take pressure off other parts of the health system, particularly by avoiding “clogging up” A&E departments. He adds: “Sometimes, for example, the system might determine that the person with a squirrel bite can just contact their GP for a tetanus jab and they don’t need to actually go and sit in a hospital.
“It will depend on things like the extent of the wound, whether there’s any underlying tissue exposed. The system is built by clinicians and doctors. who have got the medical knowledge, for us, who are health advisors, to use it.”
The job requires emotional resilience. Staff are trained to deal with life-threatening emergencies too. Jack says: “You just need to move on from one call to the next, because the next call needs you as much as the last one.
“But for all of our staff, if you have an emergency call — for example, CPR or dealing with a patient who’s sadly passed away — we always offer the health advisor five or 10 minutes off the phone.
Health advisor Jack takes calls from patients like Bob, who had appendicitis (Image: NHS)
“Everybody resets themselves in different ways. I’m a great believer in prayer. Some people reset by just carrying on to the next call or going outside and get some fresh air. It can be an emotional job. You’re dealing with a lot of things in a short space of time, especially when we’re busy.”
The majority of callers are “just very grateful and happy to be helped”, Jack adds. “It’s the great leveller, isn’t it? It doesn’t matter whether you’re the King or you’re sleeping rough. You need healthcare.
“You do get some angry callers. We have a set tolerance level for people who become abusive, which is a minority. There have been cases where people have been prosecuted because they’ve been repeated offenders, so we do take it seriously.”
Bob Peal, 61, is among the millions of patients who have turned to 111. He dialled for help in November 2024 while suffering from worsening abdominal pain. He recalls: “I was getting stomach pains from about the Wednesday.
“On Friday I rang the GP, but I was a bit after 8pm so they didn’t have any appointments. I decided, ‘Oh well, I’ll just leave things’, but by Saturday morning it got really bad.”
Bob, of Ipswich, explained that he was suffering from both a constant dull ache and sharp pains. He was phoned back within 30 minutes by a doctor who arranged an appointment at a nearby medical centre.
The father-of-one was diagnosed with appendicitis and sent straight to his local hospital for keyhole surgery. He says: “I must have rung up about 9am in the morning. I was seen by the doctor before 11, and I was in the hospital by lunchtime. It was really good. There wasn’t the four hours sitting around in A&E. By the end of the day, I’d had the appendix removed.”
Bob was discharged with antibiotics the next day. He adds: “I would encourage people to use the service because it was great, avoiding all the drawbacks of the GP.”
While health advisors like Jack can handle the initial triage, 111 relies on a secondary layer of clinically trained staff to manage complex cases. Clinical advisor Natalie Randall, 46, is part of that safety net. The mum-of-three walked away from a corporate career as a graphic designer to retrain as a paramedic in 2004, inspired by a friend’s stories from the frontline.
“It was a glamorous city life for a 25-year-old but I found myself far more interested in hearing about her gritty shifts on the road than my design career,” Natalie says. “I wanted to do something that mattered — a job where I could give something back, make a positive impact, and actually have something meaningful to say when someone asked: ‘How was work today?’”
Call handlers are also trained to deal with emergencies and can send ambulances (Image: Getty)
Looking for a new challenge and a way to balance work with caring for her sons, Natalie transitioned from the ambulance service to 111 in Ashford, Kent, in 2017. She says: “It offers many of the same things I loved about working frontline, but without the strain on my body and those long shifts that extended beyond 12 hours.
“I still get to help people during some of their worst days and there is enough diversity that no two days are ever the same.”
Natalie’s emergency medicine background means she can make decisions about whether an ambulance is needed or which treatment pathway is most appropriate. She adds: “Using services like 111 is also often so much more convenient for patients, as they can fit it around their busy lives. We want to keep people healthy and at home as much as we can.
“Sometimes people just need to talk and are struggling with loneliness or mental health issues. We used to have a frequent caller who would call up to check what she should have for dinner, and we treated her with the respect, politeness and care that we offer to all of our callers.”
The most recent data shows more than 1.7 million calls were triaged by NHS 111 in May and a further 792,000 people used the online system. The median time from the start of triage to end of care advice was around five and a half minutes.
As the service continues to grow, NHS chiefs insist calls are being answered quicker than ever — and they are encouraging more patients to trust the process.
Knowing where to turn when you have an urgent but non-emergency issue is crucial, says TV doctor and NHS GP Dr Radha Modgil. She adds: “NHS 111 can be the most convenient first step to take if you’re worried about symptoms that can’t wait and you’re not sure where to go, or when your GP is closed and you need help out of hours.
“By using 111 Online, or calling to speak to a trained health advisor, the service can connect people to the right care, or local health service, 24 hours a day, seven days a week.
“Using NHS 111 helps people get the right care when they need it, and you can easily access it online, on the phone or via the NHS App.”
NHS 111 is constantly evolving, says DR GARETH STUTTARD
NHS 111 is a gateway to the health service for patients. More than two thirds of patients contact NHS 111 by phone, and in the ten months between April last year and February this year, 17m calls were answered by call handlers.
With such large numbers, patients and families might worry how long they’ll be waiting if they call 111; but calls are actually being answered quicker than ever before by highly-trained advisors.
In the last three years, the average time to answer a patient call has dropped from seven minutes and 21 seconds to just 51 seconds. Patients are also getting call-backs from clinicians just over an hour and 20 minutes on average after speaking with 111.
But we’re not resting on our laurels. Because people increasingly turn to tech in their daily lives, NHS 111 is available online and via the NHS App where you can complete an urgent care assessment and if appropriate, get a callback from a clinician.
Ongoing improvements to NHS 111 don’t just benefit patients using that service, they help other areas of the NHS do better for patients too. Patients have told us that if they couldn’t access NHS 111 – many of them may have ended up at A&E unnecessarily. Ensuring patients get the care and advice they need when they need it allows emergency teams to prioritise the sickest patients.
Patients and their families should also be assured that when they contact NHS 111 and a situation becomes an emergency; they will get the care they need.
Both 999 and 111 are designed to identify life-threatening symptoms such as breathing difficulties straight away, so patients receive the right response as quickly as possible, and calls are escalated immediately if new information comes to light.
More and more patients tell us they are satisfied or very satisfied with the NHS 111 service, but we know there’s more we can do, and we will continue to improve access to 111 and support patients to ensure they get the right care in a way that works for them.
– Dr Gareth Stuttard is NHS England’s national clinical lead for urgent and emergency care
