Patients with non-life threatening but urgent health problems will be asked to phone 111 instead of going to A&E, under major changes aimed at stopping emergency departments becoming dangerously busy this winter.

It follows the new approach being piloted in NHS Ayrshire & Arran over November.

Around one in five people who take themselves to emergency departments are thought to be better served by other, more appropriate services.

By calling ahead, members of the public will get advice and be directed to the best way to get help with their urgent concern.

This could include self-care, out of hours or in-hours GP services, pharmacies, minor injuries units or A&E, if deemed appropriate by a clinical decision-maker.

In an emergency the advice is still to call 999.

The changes come amid warnings that hospitals in Scotland are 600 beds short of what they need to safely care for patients, resulting in long delays in emergency departments when no bed can be found elsewhere.

Overcrowding in A&Es with patients facing long waits vanished during the first wave of the pandemic, as numbers going to hospital plummeted.

Attendance levels have recovered since April but remain lower than would normally be expected, and have been starting to fall again in recent months.

During October more than 100,000 people attended A&E at hospitals in Scotland.

Numbers waiting more than eight hours in the most common ‘type 1’, or major 24 hours, emergency departments increased by 86% on the month before to 1,409.

Announcing the roll-out, Health Secretary Jeane Freeman said the changes would “continue to help our doctors and nurses through this pandemic, and ensure A&E provides the fastest and most appropriate care for people when they really need it.”

When the pilot was announced, the British Medical Association Scotland voiced concerns about the “potential unintended consequences” of the plans.

Dr Andrew Buist warned of “extra pressure” on already stretched primary care services and said some patients could have problems accessing the new model of care.

Under the plans each health board will establish a ‘flow navigation centre’ that will receive referrals from NHS 24, which runs the 111 service.

Patients are to be offered ‘rapid access’ by phone or video consultation with a ‘senior clinical decision-maker’.

In cases where A&E is deemed appropriate, appointment slots may be scheduled by the centres to minimise the risk of emergency departments becoming dangerously busy.

Speaking to healthandcare.scot about the changes when the pilot was launched, John Thomson, Scotland Vice President of the Royal College of Emergency Medicine, said: “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.”

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