IT'S DRESS-DOWN day so the staff are in their jeans and jumpers, chatting into their headsets and scribbling notes.
Like any call centre, supervisors pace the floors, attending to raised hands, and the computer screens flash up calls waiting and customer details. But on the second day of the New Year, while most Scots are lounging at home or visiting the sales, th
e staff of the NHS 24 east of Scotland call centre are far from relaxed.
With most of Scotland's GPs enjoying eight days off work between public holidays and weekends over the festive period, Scotland's out-of-hours medical emergency service is at full capacity with people calling up for advice.
Unlike the average GP surgery, where watching the comings and goings of doctors and patients can offer a glimpse into the workings of the NHS, its controversial call centres are often shrouded in secrecy. So what goes on behind its closed doors at the busiest time of year?
The east of Scotland centre, based in South Queensferry, sits in an industrial park beside a Burger King and a neon-lit Frankie and Benny's restaurant. But its highly-charged atmosphere could not be further apart from its fun-loving neighbours. It might be dress-down day, there might be crisps and cakes laid on in the staff room and tinsel round the banisters, but over the holidays the telephone hotline is geared up to handle about 13,000 calls a day and at peak moments a new call comes in every two seconds.
Snatches of the one-way conversations from the call handlers and the nurses who give out the advice are fascinating – peculiar rashes. funny spots, boils. "When you say he's off-colour, what colour is he?" Calls logged include: "Child has not urinated for 10 hours."
Anecdotes from the staff are even more mind-boggling, like the patient who phoned in because she had accidentally taken her dog's heart pills instead of her own. Or the lady who got lemonade into her eye and couldn't open it. Of course, there are real emergencies, and in these cases the nurses' laminated bright red cards are held up for help and second opinions, But mostly it's seasonal coughs and other common complaints. The 1,000 NHS 24 staff across Scotland were each required to work over the festive period to soothe them.
Staff come to NHS 24 knowing they are likely to be required to work Christmas and New Year, but accept it's all part of the job. Lynne McPhillips, a call handler, was working on Christmas Day. "Some of the callers wished me a Merry Christmas, but it didn't feel like Christmas," she says. "But the rest of the year this job suits me because I'm happy to work evenings and weekends. You never know what you are going to get on the phone. You think you've heard everything and then something else comes along, like someone calling because they wanted to know how to clean computer ink off her son's hand. Other people you feel really sorry for, living on their own."
Dr George Crooks is the service's medical director, a jovial, silver haired ex-GP, the sort you once would have telephoned directly in the old days when doctors provided 24-hour cover themselves. He would have taken the call at home, then come out to see you dispensing medicine from his leather case. Now he presides over a highly-specialised computer network like an internet mogul, talking about algorithms and 10-minute call volume predictions, holding a virtual network of care for Scotland's sick in the palm of his hand.
Crooks explains why the service peaks on the first few days after the New Year. "You've got to get into the heads of the Scottish public," he says. "Demand is affected by a number of things. If people have things to look forward to such as family parties, they tend to focus on their lives. But after January 1, with two or three days before their doctor's surgery re-opens, they would rather deal with it now. The other factor is the winter, there has been quite nasty weather and we are seeing a lot of winter illnesses and flu-like symptoms."
The computer wizardry of the service cannot be underestimated. Sitting alongside the nurses are systems experts who monitor the number of staff on duty, the number about to take breaks, and the number of calls sitting on the BT exchange about to come in. This ensures each call is answered within three seconds.
Although NHS 24 has overcome many of its troubles, it's impossible to write about the service without mentioning them. There was a torrent of criticism when the telephone hotline was set up in 2002 to take over from GPs in the evenings and weekends. The idea of a nurse handling a potential emergency over the phone using flowcharts did not sit well with the public and to this day many, including some doctors, remain unconvinced it's suitable.
A notice in the call centre warning staff about meningitis cases provides a stark reminder of one of the low points the service reached when a damning inquiry into the death of a toddler, 20-month-old Kyle Brown, from Edinburgh, found serious flaws in the organisation of NHS 24 and ruled his death from meningitis in 2006 could have been avoided if NHS 24 staff had called an ambulance.
But Crooks is emphatic about the safety nets now thrown up around the call queue to avoid a repeat of the catastrophe. For example, calls are either classed urgent or non-urgent. The urgent calls are answered immediately by a nurse. The non-urgent are dealt with using a call-back system. Each time a case is classed as non-urgent the notes are double-checked by a senior nurse, the equivalent of a deputy matron, to make sure that they are not missing vital clues to a serious condition. And the reality is that NHS 24 is here to stay for the foreseeable future. Doctors certainly don't want to return to the old days. As Crooks insists: "It's now an integral part of the NHS."
