Patients could be urged to call 111 to book A&E appointments

17 September 2020, 00:50

Patients requiring A&E will be urged to book an appointment first through NHS 111 as part of a major shake-up of emergency services.

If pilots are successful, the scheme could be rolled out to all NHS trusts by December, with patients told they should call ahead and book a space in the emergency department.

The move is being made in response to the Covid-19 pandemic, with experts believing it makes sense to triage patients by phone or online rather than having people sitting around in waiting rooms.

The Government also wants to reduce pressure on emergency departments as staff battle winter pressures, including from coronavirus and seasonal flu.

A campaign called Help Us Help You will launch later in the year to urge people to use the new service.

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The 111 pilots are currently live in Cornwall, Portsmouth, Hampshire and Blackpool, and have just begun in Warrington.

Health secretary Matt Hancock said: "We are investing £450 million to make sure our A&E departments are ready for winter.

"Hospitals around the country will be able to expand and upgrade to ensure they can continue safely treating patients in the coming months.

"During the peak of the pandemic we saw millions of people using NHS 111 to get the best possible advice on Covid-19, and other urgent NHS services.

"These pilots will build on this and test whether we can deliver quicker access to the right care, provide a better service for the public and ensure our dedicated NHS staff aren't overwhelmed.

"We all need to play our part by washing our hands regularly, using a face covering and keeping our distance from those not in our household. We are determined to protect the NHS as we did during the peak."

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The Department of Health and Social Care said more NHS 111 call handlers are being brought in to take on the additional workload, alongside extra clinicians.

A consultation on new targets for waiting times in A&E is also being launched as ministers prepare to scrap the current four-hour target.

Under the new changes, patients will still be able to seek help at A&E without an appointment, but officials say they are likely to end up waiting longer than those who have gone through 111.

The idea is that NHS 111 workers direct patients to the most clinically appropriate service, including A&Es, urgent treatment centres, GP surgeries or mental health care.

People with a life-threatening condition should still call 999.

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As part of the announcement, the Government pledged an extra £150 million of funding to expand and upgrade 25 more A&Es to reduce overcrowding and improve infection control ahead of winter.

It said this was on top of £300 million announced for 117 trusts to upgrade their facilities.

Data from the Department for Health and Social Care suggests there are 14.4 million A&E attendances in England that have not gone through NHS 111, a GP or via an ambulance.

It said 2.1 million attendances do not result in admission or treatment.

Dr Cliff Mann, NHS national clinical director for urgent and emergency care, said: "While emergency admissions are now back to near normal levels and 999 calls are actually above usual, Covid infection control means rethinking how safely to look after people who might previously have been to an emergency department for a more minor condition.

"Local teams are working hard to expand and adapt services to ensure people can continue to get the care they need safely, whether that's in hospital or closer to home.

"This additional investment will help us continue the development of NHS 111 and provide a broader range of services, with direct booking that will ensure all patients can see the right clinicians in the right setting, and address the extra challenges posed by Covid-19 so that emergency departments can safely treat those patients who do require their services."

Dr Katherine Henderson, president of the Royal College of Emergency Medicine, said: "Expansion of NHS 111 will help patients to be seen more quickly by the service most appropriate to their needs.

"We are pleased to have reached the consultation phase of how A&E performance is measured with a focus on the safe, timely care of the very sickest patients, and look forward to the publication of the proposals."

Chris Hopson, the chief executive of NHS Providers, said trusts will welcome the funding, as it will "enable them to provide better care for their patients this winter" and said the 111 proposals are the "right approach".

He said: "The proposals to use 111 as a key 'front door' to emergency care and redirect patients to the right service, avoiding the need to attend busy emergency departments when not required, are the right approach.

"They have been developed after extensive work between national and local leaders. It is appropriate that they should be properly piloted before they are fully rolled out but we are hopeful these pilots will prove successful."

Caroline Abrahams, charity director at Age UK, said the booking scheme could have advantages for many older people.

"As the year goes on, and with Covid-19 cases on the rise, older people will be keen to avoid crowded places so if this new system means they don't have to hang around for so long in an incredibly busy A&E but can go for a defined time slot instead, many will welcome it," she said.

"However, it is important to stress that older people who have difficulty using the phone will not be turned away if they go straight to A&E as before.

"As this new approach beds in we will need to keep it under review to make sure it is not inadvertently leading to some older people failing to access the treatment they need."