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'It’s unusual using a phone to talk to patients when you are used to bedside care'

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NHS Direct saves the health service millions by reducing attendances at A&E and GP practices. We talk to Antonina Kimonge to find out what it takes to be the voice on the end of the line.

If you had told nurses in 1960, 1970 or even 1980 that they could advise and recommend treatments for patients without seeing them, they’d stare in disbelief.

If they have a problem with their arm, you look at your own arm and imagine what they are describing

But NHS Direct, which has 13,500 calls to its helpline each day and more than 450,000 website visitors every month, is proof that such a system is not the plot of a futuristic novel.

NHS Direct is estimated to have saved the NHS £213m in 2009-10 through reducing attendances at accident and emergency departments, GP practices and other face-to-face services.

This is thanks to its band of 1,400 nurse advisers at 32 sites. They believe it is an exceptional service for both patients and their careers.

Antonina Kimonge is a nurse adviser who has been at NHS Direct for six years. Like all the nurses employed at the organisation, she has worked with patients face to face. She previously worked at Luton and Dunstable Hospital and, before that, in a surgical unit in London looking after high-dependency patients.

What attracted her to NHS Direct was the desire to do something different and the flexibility of the working life.

“It’s unusual using a phone to talk to patients when you are used to bedside care, but it’s not as different as you may at first think,” she says.

In her 7.5 hour shifts, she handles up to 40 calls, and says it feels special to be able to help so many people. The nature of the calls varies. In the winter, they are mainly about colds, flu or sickness; in the summer, they are often about bee stings and hay fever.

What Ms Kimonge enjoys is being a lifeline for those most in need or who are vulnerable, such as older people living alone.

She maintains you can give good care without seeing patients if you listen to them and build up a mental picture.

“If they have a problem with their arm, you look at your own arm and imagine what they are describing. You get better at this with experience,” she says.

The nurses undergo six weeks training, which enables them to translate their skills to this different environment. It teaches them how to visualise the symptoms, as well as how to talk to patients.

Unlike the healthcare advisers on the frontline of NHS Direct, they are not given a matrix to work through but use their own initiative. However, they must still offer consistent advice.

Ms Kimonge points out that her work is not about diagnosis, but offering good advice and making sure patients know where to get more help, for example from a pharmacy, the GP surgery or A&E.

The role is intense and requires exceptional communication, listening and critical thinking skills.

The success of NHS Direct - which has taken on running GP out-of-hours services and fielding less urgent calls to a few local ambulance services - means the career opportunities are huge.

NHS Direct nurses say that the skills they have gained are invaluable when assessing patients in other settings.

Many senior clinical staff at NHS Direct have worked as nurse advisers. Some nurse advisers have moved onto senior posts in the NHS.

Last year, the organisation introduced a new band 5 role to offer nurses the opportunity to gain wider clinical experience. This also allows band 6 nurses to improve their coaching and leadership skills.

“I feel fulfilled and happy to work here,” says Ms Kimonge. “I get the same buzz that I got from looking after people in hospital. You can make a difference. I have made referrals to the child protection services, and I have been glad that I was there to do it.”

She says she gets a real sense of achievement for herself and her patients - without ever seeing them.

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Readers' comments (2)

  • As a former nurse who worked for NHS Direct I agree with the positive comments of the author. However, it needs to be matched with the reality of working in a call centre. You find you have every breath taken monitored by the management, whose only objective is to maximise the speed the nurse works and minimise the support or empathy that is used with the patients. I wouldn't dream of working there again!

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  • Absolutely agree with the above post. Having also worked for NHSD I enjoyed the patient contact and felt that many times we were offering a valuable service. When you are expected to complete a call in the minumum time regardless of whether callers have a cold or are contemplating suicide then it's a different matter. Having your work plotted on a graph for a review each month was an eye opener too to see if targets were being met. After a while it becomes a bit souless.

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