Table 2

Suggested guidance and examples to use during NHS 111 audio consultations for paediatricians in training

ContextAreaGuidance and examples
Consultation introductionIntroduces self and establishes the identity of the caller(s), ensuring confidentiality and consent.
  • “Good Morning, my name is Dr X. I am a children’s doctor working with the 111 service.”

  • “Before we start, please may you confirm your child/young person’s name, date of birth and address?”

  • “Are you happy for me to access your child’s GP/secondary care records?”

  • “Are you happy for information we discuss today to be shared with your GP?”

Establishes rapport.
  • “Can I confirm your name and relationship to the patient?”

  • “I understand, from my colleague that you spoke to earlier, that you rang NHS 111 to discuss … I was now hoping to go into a bit more detail.”

  • “How can I help you today?”

Information gatheringIdentifies reason(s) for telephone call and excludes the need for emergency response in a timely manner (when appropriate), demonstrating safe and effective prioritisation skills.
  • “Since you spoke to the call handler/my colleague, has there been any change in your child’s condition that you would like to bring to my attention?”

  • “Are you more worried about your child now than you were when you called NHS 111 and spoke to my colleague earlier… if so, can you tell me what’s most worrying you…”

Encourages the caller’s and/or the patient’s contribution using appropriate open and closed questions, demonstrating active listening and responding to auditory cues.
  • Open questions, such as “Tell me what’s been going on?” or “How can I help?”

  • Demonstrate active listening: “You said your daughter’s been having abdominal pain, can you tell me more about that?”

  • Move onto closed questions appropriately: “When did the problem start? Has medical attention been sought before now? Have there been similar episodes in the past?”

  • “Is there anything we haven’t already covered that you would like to tell me or that you are worried about?”

  • If the caller is not the patient, consider asking whether it is possible to speak to the child or young person directly, if developmentally appropriate.

Explores the patient’s health understanding/beliefs, including identifying and addressing the patient’s ideas, concerns and expectations.Three key areas:
  • Ideas: “What do you think the problem is” and “What are your thoughts about what is happening?”

  • Concerns: “Is there anything that particularly concerns you?”

  • Expectations: “What were you hoping I might be able to do to you?” and “What do you think might be the best plan of action?”

It can be helpful to summarise what you have been told about the presenting complaint and then check whether there is anything else you have overlooked.
Defining the clinical problemTakes an appropriately thorough and focused history to allow a safe assessment (includes/excludes likely relevant significant condition).
  • Include medical history, birth history, drug history, allergies, immunisation status, family history, social history (if time, to include who is with the child, who holds parental responsibility, type of accommodation the child lives in, happiness at home/school, smoking status of the patient/parents, current/previous contact with social care).

  • Obtain information by direct observation of sounds on the call or video where available.

Makes an appropriate working diagnosis.
  • “There are a couple of possible diagnoses, but I am keen to rule out… by…”

Constructing the management planCreates an appropriate, effective and mutually acceptable treatment plan (including medication guidance) and management outcome.
  • If there are options for treatment, then share this with the patient.

  • Explain what the plan is so that the patient will understand. For example: “This is a flare up of your child’s eczema, I will prescribe an ointment which I would like you to apply to the affected parts twice a day for 7 days. You should start to see an improvement in 48 hours.”

Emergency managementDetermines the need for an emergency admission and appropriately asks questions to cover emergency conditions.
  • Remember to document important positives and negatives to show the emergency conditions have been considered.

PrescribingAble to generate a prescription and to send to an appropriate pharmacy in consultation with the patient.
Adherence to local antibiotic and prescribing guidelines.
  • “I am going to send a prescription to …. Pharmacy which I can see is open 24 hours. You will need to collect the medication from there.”

Closing the consultationSeeks to confirm the patient’s understanding.
  • Summarise the key points back to the child and the parents/carers.

  • Check if there are any questions or concerns that have not been addressed or that the patient/parent/carer would like you to go over again.

Provides appropriate safety netting and follow-up instructions.
  • “If your child does not improve by … then please seek further help by…”

  • “If your child becomes short of breath or unable to speak in sentences, please call 999.”

Effective use of the consultationManages and communicates risk and uncertainty appropriately,
  • “This infection is most often caused by a virus and it will usually go away by itself. Signs of a bacterial infection which would mean you may need antibiotics include…”

Appropriate consultation time to clinical context (effective use of time, taking into account the needs of other patients), with effective use of available resources.
  • The consultation is succinct but thorough in the use of time for both the caller and the paediatrician.

  • Signposting to information resources, if relevant, is helpful to the parent/carer and can be reassuring.

  • The paediatrician should be aware of the children’s queue and the prioritisation of cases in the queue, as would happen when the paediatrician would be working on in an emergency department.

Accurate, relevant and concise record-keeping to ensure safe continuing care of the patient.
  • Documentation of safety netting advice that has been given, including the important positive and negative aspects of the patient’s condition.

Addressing safeguardingConsider safeguarding with every child.Is there contact with social services? Who is at home? Is this appropriate?
  • “We ask everyone if they have contact with social services. Do you have a social worker or have you ever had contact with social care?”

  • “Who is with you at home at the moment?”

  • “If you need to bring your child to hospital, who will look after your other children?”

  • NHS, National Health Service.