A telephone triage system developed by Connecting for Health to direct patients to the most appropriate forms of care appears to be increasing pressure on emergency services, HSJ has discovered.

NHS Pathways involves the collection of detailed information about the patient, their clinical need and its urgency. An algorithm is used to match them to services available locally.

It is one of only three clinical assessment tools approved by the Department of Health for use in the new NHS 111 service and is expected to be used by the majority of providers of the non-emergency telephone number, as well as by most ambulance trusts for 999 calls.

North East Ambulance Service Foundation Trust, the first pilot site for NHS 111, has been using Pathways since 2006. However, the three major ambulance trusts that have introduced the NHS Pathways system since March 2011 have seen a rise in the number of calls classified as category A - the most serious, life-threatening cases.

South West Ambulance Service Foundation Trust saw the proportion of calls classified as category A calls jump from 23 per cent during 2010-11 to 36 per cent in the first quarter of 2011-12 following the introduction of pathways in March 2011. In June this year the figure was 32.5 per cent.

DH data shows South East Coast Ambulance Service Foundation Trust and West Midlands Ambulance Service Trust also saw steep rises in the number of category A calls after the system was introduced, the former with an increase of 13 per cent in the year to June and the latter a 20 per cent rise.

Ambulance trusts that have not introduced NHS Pathways saw a 6.5 per cent increase over the same period. Peter Bradley, DH national ambulance director, said: “One of the perceived benefits of pathways was they would end up with a lot less category A calls. That’s not been the case.” However, he insisted the system had identified alternative to traditional ambulance responses.

A report to South West Ambulance Service’s board in July said calls to its out-of-hours GP service were being classified by Pathways as urgent when it would have been clinically appropriate to downgrade them. This was blamed for an increase of 20-25 patients a day attending Royal Cornwall Hospitals Trust’s emergency department.

However, a spokeswoman for the DH said there was “no evidence” Pathways was increasing demand on emergency services. She added: “All aspects of the system are based on the latest clinical evidence and practice and any proposed changes are considered and agreed by this independent group.”

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