| Professional values, behaviour and knowledge | To conduct an effective and safe consultation for CYP in NHS 111. |
Takes practical steps to ensure privacy during a remote consultation. Navigates the NHS 111 software confidently. Reviews all available information, noting and taking account of any conflicting, confounding or unusual aspects. Recognises accurately and promptly the differentiating features of commonly occurring conditions presenting in unwell CYP. Forms an accurate and justifiable identification of the nature and severity of the child/young person’s condition, likely causes of the individual’s health problems, implications of pre-existing and other medical problems, prognosis and related needs. Uses the NHS 111 telephony system/s and video links (where available). Accesses and navigates the Directory of Services.
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Accesses the paediatric CAS queue or identifies paediatric patients requiring a call back. Recognises the acuity/priority rating of a case. Reviews patients’ General Pracctice (GP) records, where available. Reviews patients’ outpatient/secondary care records, where available. Reviews patients’ previous 111 consultation records, where available. Calls a patient, confirming two patient identifiers and, where required, the caller’s relationship to the patient before proceeding with consultation. Takes the clinical history and documents this in the appropriate place in the patient’s 111 records. Performs a remote examination which may include observing the child undertake different activities, or looking at a rash, via a video link (if available). Maintains full, accurate and legible records. Seeks guidance from colleagues regarding complex cases, if/when required. Identifies and makes use of relevant research and findings from evidence-based practice to inform interpretation. Balances any additional or unusual aspects of the child’s or young person’s presenting features against their overall presentation. Locks cases, seeks advice and arranges to phone the patient back where there are uncertainties.
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Mini-CEX*. CBD†. Reflection.
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| Professional skills: communication | To communicate effectively with CYP or carers during an NHS 111 consultation. |
Obtains a complete and accurate history of the presenting child or young person. Adapts approach for families with difficulty accepting advice or accessing NHS systems. Accurately and promptly identifies the additional information needed to make a differential diagnosis. Communicates an appropriate plan. Provides appropriate safety netting advice.
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Introduces self, explaining own role. Explains what the consultation will involve. Addresses the patient’s and/or the parent’s/carer’s ideas, concerns and expectations. Confirms the presence/absence of red flags—relevant to the presenting complaint. Advises the child or young person and/or parents/carers of the diagnosis/possible diagnoses at the earliest opportunity and in a sensitive manner. Confirms the caller’s understanding of the management plan. Works with family and other professionals to understand and resolve any difficulties CYP or family may have in following advice. Sets out safety net advice and signposts to appropriate resources, where indicated. Uses a professional interpreter appropriately. Provides opportunities for the child or young person and/or carers to ask questions and develop their understanding of the diagnosis/possible diagnoses. Manages emotional sensitivities appropriately, including anxiety, anger and fear. Signposts to appropriate self-care resources.
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Mini-CEX*. CBD†. DOC‡. Reflection.
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| Professional skills: patient management | To make an appropriate and safe management plan for NHS 111 CYP. |
Uses all available information to develop a differential diagnosis which is justifiable given the information available at the time and likely to result in the optimum outcome for the child/young person. Synthesises available information and formulates an appropriate management plan that can be communicated over the phone. Follows appropriate procedures and protocols to arrange for any investigations or observations needed. Re-evaluates initial diagnosis in light of emerging symptoms/signs.
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Combines information from history and previous notes with objective assessments of current status. Notes current observations from family, both volunteered and obtained by direct questioning. Makes own observations of sounds from child and family heard on the call. Uses video inspection of child and surroundings when available and appropriate. Uses this information in full clinical assessment. Selects the appropriate disposition to code the patient’s end pathway correctly, where this is possible. Documents the management plan and appropriate disposition on the patient’s records. Arranges an ambulance callout, when required. Advises on which emergency departments are closest/most appropriate for the patient to attend. Advises on which out-of-hours GP or other service they may attend, including providing practical information, for example, about opening hours. Books a patient directly into an out-of-hours GP appointment using the direct appointment booking system, where available. Books a patient directly into an emergency department slot, where available. Checks that carers know how to get to the chosen facility. Initiates symptomatic treatment at the earliest opportunity, in line with national, local and organisational guidelines and protocols. Initiates action to provide the best possible outcome for CYP.
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Mini-CEX*. CBD†. ACAT§. Reflection.
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| Health promotion and illness prevention | To identify and use opportunities to promote healthy behaviour through the NHS 111 consultation. |
Considers the impact of social factors on health. Increases the family’s confidence to manage minor illnesses at home. Screens for potential mental health and social difficulties.
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Provides sensitive advice about common problems of infancy. Provides smoking cessation advice, if appropriate. Enquires about weight and signposts to local weight management resources. Signposts to appropriate self-care resources. Advises to see GP for/or access psychological services, if required.
Note: There may not always be sufficient time to explore these in an acute consultation so this must be done based on sound clinical and professional judgement. |
Mini-CEX*. CBD†. Reflection.
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| Leadership and team working | To manage the team effectively during an NHS 111 shift to ensure optimum outcomes for CYP. |
Demonstrates awareness of other clinicians and professionals on shift, supporting where appropriate. Involves the multidisciplinary team, where required.
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Uses internal communication systems, for example, ‘Webex’, to communicate with other clinicians/colleagues on shift and give paediatric advice when appropriate. Involves appropriate team members, where the patient could benefit from additional expertise.
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| Patient safety, including safe prescribing | To prescribe safely within the NHS 111 consultation and to ensure patient safety at all times in NHS 111. |
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Documents need for a prescription. Prescribes via the electronic prescribing system or equivalent (where available). Submits an incident report when indicated.
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| Quality improvement | To identify and evaluate possible improvements to the NHS 111 service for CYP. |
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Carries out a close-loop audit/quality improvement project in NHS 111. Brings new ideas to the IUC, for example looks at examining alternative pathways for CYP in a local area.
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| Safeguarding | To look for and be able to identify safeguarding concerns during an NHS 111 consultation. |
Recognises signs of abuse/other safeguarding concerns. Shows awareness of local safeguarding procedures. Works in compliance with child-related legislation at all times.
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Completes level 3 safeguarding training. Completes local safeguarding training. Promptly reports any safeguarding concerns to the appropriate person, in line with national and organisational policy. Escalates to NHS 111 safeguarding team or duty social worker/police if appropriate. Completes relevant paperwork associated with escalating a safeguarding concern, following up when appropriate. Demonstrates awareness and appropriate use of ‘Do not attend’ policies where direct booking has been arranged.
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Mini-CEX*. CBD† Safeguarding CBD¶. DOC‡.
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