Planned changes to urgent care that will see members of the public asked to call ahead before going to A&E with non-life-threatening injuries or illness can be viewed as a way to protect the NHS over winter.

But the reforms will also be good for patients, a leading A&E doctor has told healthandcare.scot.

Dr John Thomson, Scotland Vice President of the Royal College of Emergency Medicine, stresses that people who do not need to be in emergency departments will receive more appropriate care.

“Anyone who feels they have an urgent health problem that is not life-threatening should phone 111,” he says.

“If you’ve got a life-threatening health problem you phone 999 and come to the emergency department. There is no change to the way emergency care is accessed or delivered.

“This is actually about people who don’t need to be seen as an emergency who can be scheduled in a more controlled fashion.”

Up to 850,000 people bring themselves to emergency departments in Scotland each year without having been referred by their GP, NHS 24 or out-of-hours services.

It’s thought that around 20% of those – up to 170,000 – could have been better served by a different part of the healthcare system.

Under the new plans these patients would be identified when they call 111, where a clinical decision-maker would direct them to the most suitable form of care at the right time.

“That allows you to schedule attendances and map them out so there are no particular surges that would put undue pressure on the health service at any given time,” says Dr Thomson.

“There’s no real change in the care of the patient – it’s just happening in a more scheduled fashion.”

It’s hoped the changes will prevent emergency departments becoming dangerously busy this winter, a concern the Royal College of Emergency Medicine has raised previously.

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

“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.”

A&E had become a ‘safety net’ for patients who were unsure where else to go or when other services were closed, Dr Thomson believes. He argues the new system will make this clearer.

“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.”

He adds: “We know that exit delays and prolonged breaches [of waiting times targets] lead to increased morbidity and mortality.

“There is good evidence from Australasia and Ireland that shows if you’re on an emergency department trolley for a number of hours longer than you need to be, your risk of being at significant harm increases.

“This will undoubtedly benefit patients but it will also benefit the patients that need to be in emergency departments by reducing crowding.”

 

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