Exclusive: National roll-out of ‘call before you walk’ A&Es set for winter

Trials of new systems to prevent overcrowding in emergency departments ahead of a potential second wave of covid-19 in the winter are taking place at hospitals in Portsmouth and Cornwall and are due to shortly be expanded to other areas such as Newcastle, HSJ can reveal.

London is also experimenting with introducing the system, having pulled back from an earlier proposal to roll it out it rapidly, shortly after the covid-19 peak.

In the trials, NHS 111 has acted as a “triage point” enabling patients not facing medical emergencies but needing urgent treatment to book access to primary care, urgent treatment centres or same-day emergency “hot clinics” staffed by specialists. 

Patients are discouraged from attending without an appointment, but they are able to do so; and sources said performance targets would continue to apply to them, although these were already subject to review pre-covid.

Both the Royal College of Emergency Medicine and NHSE are now hopeful a new triage system for emergency care can be in place by the winter. HSJ understands an announcement on the plan is likely before the end of the summer.

Katherine Henderson, president of the Royal College of Emergency Medicine, told HSJ: “We need to do something before we go into winter. Everyone recognises the risks of going into winter without a system that helps patients get the care they need without necessarily going face to face.

“We need our emergency departments to be there for the most seriously ill and injured. What we can’t do is go back to having crowded departments.”

A source close to the trials said NHSE’s ambition is that every NHS111 provider will be acting as a triage point for emergency departments before winter.

The source told HSJ that A&E performance metrics, such as the four-hour target, would remain in place even for patients who do not use the triage service. However, the future shape of emergency care targets remains unclear — NHSE was due to report in March on its review of emergency care targets, with an expectation it would seek to phase out the four-hour target.

NHSE hopes to convince the public to use the new triage service by making it the most convenient way to access emergency care, with less waiting due to being given time slots in advance, and a “more bespoke service”, the source added.

If the plans are to succeed, more NHS111 calls will need to be handled by clinicians, who can give advice which does not require an ED visit. NHSE hopes the increased number of clinicians needed to work for NHS111 as “clinical advisers” would be staffed at least in part from the 1,500 doctors currently working for the covid clinical assessment service, and other clinicians working for the service part time, the source said.

The system also requires hospitals to be able to receive the bookings, and the necessary range of clinics and alternative services to be available. 

Portsmouth Hospitals Trust and South Central Ambulance Service FT is using NHS111 as a triage point for the emergency department at the Queen Alexandra Hospital in for patients whose conditions are not considered medical emergencies.

Patients who arrive without first contacting 111 will still receive emergency care if they need it, but those who call in advance can get a booked time slot. People experiencing medical emergencies are still being encouraged to call 999 or attend ED.

Stephen Powis, national medical director for NHS England, told the Commons health and social care committee last month: “We want to move, as we wanted to move before covid, increasingly to a 111 first model that ensures we do everything we can to give appropriate advice to signpost people to the most appropriate place for treatment.”

Updated at 3:25pm with updated information from NHSE.