• RCEM president says “beefed up” 111 service should triage emergency patients
  • “Call before you walk” service would prevent crowding in A&Es
  • Warnings of “existential threat” to dentistry

A ‘call before you walk’ system to prevent overcrowding and the spread of covid-19 in emergency departments should be implemented alongside a ‘beefed up’ NHS 111 service, a senior figure has said.

Katherine Henderson, president of the Royal College of Emergency Medicine, told MPs a “triage point” such as NHS 111 should be available for patients needing urgent treatment and be able to book access to primary care, urgent treatment centres or same-day emergency “hot clinics” staffed by specialists.

She told the Commons health and social care committee she did not envisage A&Es would turn away people in desperate need of care, but said before the pandemic they were being used as a “safety net for the system” and becoming “very overcrowded”.

Dr Henderson said technology should also be used to “track” whether patients have followed the advice of 111, such as whether they turn up to appointments, and said trusts should consider alternative ways in which patients can access same-day emergency care.

She told the committee today that the “call before you walk” model for emergency care, which is used by some Scandinavian countries, should be adopted by the NHS in the long term.

“[Emergency departments] were able to have an infinite number of patients, we were never able to say ‘we’re full, we’re at capacity,’” she said.

“We now need to recognise we can’t do that in an era where we need to keep patients safe, and the patients that need to be able to come to an emergency department […] are some are some of our most vulnerable, and are most at risk if they do pick up covid. So if we cannot have space to put those patients, we’re going to cause enormous problems and harm to patients.

“[We need to have] some way of knowing who’s coming, and making sure that the right patients are coming to the emergency department and there are other routes of access to care for urgent patients but maybe patients who are not needing emergency care.”

MPs were also told dental surgery is facing a “probably existential” threat due to the pandemic, by Mick Armstrong, British Dental Association chair.

He said it would be “very difficult” for dentists to increase the number of aerosol generating procedures, from 10-15 per cent now, under current guidelines, while only 8 per cent of practices believe they are financially viable.

Derek Alderson, president of the Royal College of Surgeons, also said patients were waiting “unacceptably long” periods of time for surgery, with people waiting for joint surgery among the largest groups. He also highlighted the risk death rate for surgical patients if they are infected with covid.