More than £40m has spent on reforms to change the way the public access urgent care and reduce pressure on A&E departments.

Some £20m was allocated to the project in 2020/21 and a further £23m in 2021/22. Another £500,000 was spent on the ‘right care, right place’ national marketing campaign that saw leaflets being sent to homes across Scotland.

Now the Reform of Urgent Care programme is set to be independently evaluated to determine whether the investment represents value for money.

More than half of the funding has gone to NHS 24, which handles the 111 call service, according to information supplied after a freedom of information request.

Patients contacting 111 with a non-life-threatening urgent problem are then put in touch with ‘flow navigation centres’ (FNC) run by regional NHS boards, which then direct patients to the most appropriate local care such as their GP, local pharmacy or a scheduled A&E appointment.

Previous evaluations have repeatedly raised concerns about call delays at NHS 24 that have seen waits of up to 25 minutes at peak times and warned the process could complicate not simplify the patient journey.

Beyond NHS 24, the remainder of the funding is split between NHS boards to support implementation of the programme.

In December a report to the NHS Lothian board said referrals via 111 to the flow navigation centre “remain low” despite a national communications campaign launching earlier in the year.

On average 65 people are directed to the FNC each day in Lothian, with 38 provided with a scheduled minor injuries assessment.

Chief Executive Callum Campbell previously told the board call delays at NHS 24 could be “frustrating” for patients. The board said in August that there was ‘no conclusive evidence that [RUC] was having a positive or negative impact on waits’.

A review last year found the reforms had diverted a ‘relatively small’ number of patients from A&E and needed ‘rapid refinement’.

Roughly four in ten people in market research commissioned by the Scottish government recalled seeing the national campaign, which ran ads in press, social media, TV and radio.

The evaluation, released following a freedom of information request, said the campaign had performed “incredibly well” and increased the likelihood of people calling 111 before accessing A&E.

In response to the FOI, the government said: ‘An evaluation programme has been established to deliver a comprehensive evaluation of progress with the Redesign of Urgent Care pathway implementation and to monitor the impact on public confidence, patient expectation, satisfaction and experience, quality, safety and cost benefit.

‘To understand the value of the redesign programme we are extending an invitation to external providers to undertake a review of the programme investment. This will help inform future investment decisions. Funding for 22/23 is still to be agreed.’

Both the BMA and the Royal College of GPs have raised concerns about the programme. Over summer Dr Andrew Buist, chair of the BMA’s Scottish GP committee, said a ‘re-direction’ model used in Tayside would be “considerably more cost-effective”.

In November boards were told to follow the Tayside approach of diverting patients who could be treated elsewhere away from the emergency department if they meet certain criteria.

Read more: Excess deaths warning as long waits in A&E surge; A&E call-ahead reforms having “no impact”; 111 delays risk A&E call-ahead plan

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