A programme of reforms to urgent care that was supposed to reduce pressure on hospital emergency departments is having “no impact”, a senior clinician has said.

Dr John Thomson, Scotland vice president of the Royal College of Emergency Medicine, made the comments as performance against the four-hour A&E target fell to its lowest level on record across Scotland.

In the third week of August, one in four people waited longer than four hours to be seen, and then either discharged, admitted or transferred at an emergency department.

Under the ‘Right Care Right Place’ programme that went live in November 2020, members of the public are being advised to call 111 if they have a health problem they would normally take themselves to A&E for.

A handler at NHS 24 will then put them in contact with triage centres run by health boards, where a clinician will assess them and direct them to the emergency department or an alternative such as a GP out-of-hours service.

When it was launched it was pitched as a way of easing pressure on emergency departments, by reducing the number of ‘self-presenters’ who take themselves to A&E but could be helped elsewhere.

The Scottish government’s NHS recovery plan, published last week, suggested the scheme could reduce attendances at emergency departments by 15-20%

Speaking to healthandcare.scot about the challenges facing emergency departments, Dr John Thomson said the principle of the reforms was sound but added: “the data shows, at the moment, that it is having no impact.”

“Patients are phoning 111, they are coming through to the 111 centres as part of the redesign of urgent care, but the data shows that it’s not having any effect in terms of reducing self-presenters to the emergency department.”

A report published today said improved information about when the public should call the new urgent care service was needed.

The review, by Healthcare Improvement Scotland, also recommended quick access to interpretation and translation on 111 calls, as well as the need to consider higher travel costs in remote and rural areas.

An assessment earlier this year warned the changes were being put at risk by staffing shortages at NHS 24, which runs the 111 service, that meant call waiting times rose dramatically at weekends.

“It’s not about preventing people from accessing emergency services, we’re open 24/7 for anyone who needs us,” Dr Thomson.

“However, the sad reality is that there is a number of patients who will seek help in the emergency department and that is the wrong place for their particular needs.”

Read more: Emergency medics “very open” to new A&E target; A&E call-ahead changes go live across Scotland; ‘Extreme caution’ urged over A&E call-ahead changes

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