Members of the public with injuries that are not life-threatening will be asked to call 111 before going to A&E in a trial initiative launching on Tuesday.

The major change, which will be copied nationally if the pilot is successful, is designed to stop emergency departments becoming dangerously overcrowded over winter.

Under the plans to be trialled in Ayrshire and Arran, anyone who has an urgent problem that is not life-threatening, that they would usually visit A&E for, will be told to call NHS 24. If appropriate, they will be directed elsewhere, such as a minor injuries unit, their GP or community pharmacist.

If there is an emergency the advice remains to call 999 or go to A&E.

The ambition for everyone with non-life-threatening conditions to call ahead was part of the Scottish government’s Programme for Government plans to increase digital engagement unveiled in September.

Speaking to healthandcare.scot about the changes, John Thomson, Scotland Vice President of the Royal College of Emergency Medicine, said the move was not about appointments for A&E but instead making sure people who were not an emergency could be seen in a more controlled fashion.

Read the full interview here.

However the British Medical Association Scotland has voiced concerns about the “potential unintended consequences” of the plans.

The proposals will see an initial ‘pathfinder’ begin in NHS Ayrshire & Arran followed by a national rollout across Scotland from the start of December.

Ayrshire and Arran chief executive John Burns says it is an important move:

“We are delighted that NHS Ayrshire & Arran has been selected as a ‘pathfinder’ board. We have the appropriate pathways and processes in place, so that from 3 November, our citizens with have better access to the right care in the right place.”

Local ‘navigation centres’ will handle calls and, following a consultation with a clinical decision-maker, call handlers will direct members of the public to a range of services, including booking them in for out-of-hours GP appointments. Patients will still be directed to A&E at a safe time if this is deemed necessary.

Dr Andrew Buist, chair of the BMA’s GP committee, says the organisation continues to have concerned about the scheme:

“We have expressed concerns about the potential unintended consequences with the urgent care proposal set out by the Scottish government; we do welcome that agreement has been made to pilot in the first instance, however little time has been made for evaluation.

“The potential unintended consequences are the extra pressure it may put on primary care and the difficulties some patients may have with access.”

Emergency medic Dr John Thomson added: “This is a significant change in how the public will access aspects of the healthcare and in order for it to work the public need to understand what’s being asked of them.

“One of the biggest issues emergency departments have faced over a number of years, that disappeared during the first covid wave, is crowding..

“We know that crowding kills, we know that crowding has a very significant negative impact on patients and staff morale…this should help because emergency departments would then see patients who need an emergency department.

“In a way this will simplify the experience for the patient. If they don’t require 999, they should phone 111, which brings that senior decision-maker closer to the patient.”

Health Secretary Jeane Freeman said: “The pressure on acute capacity and the need to support infection control as coronavirus continues to spread means it is vital people get the right care in the right place to help keep people and NHS Scotland safe this winter.

“The new approach to urgent care will be tested in Ayrshire and Arran so we can learn from patients and local NHS staff, before rolling it out nationally from December.”

 

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