Trying to discourage patients from going to A&E for unnecessary visits is a “waste of resources”, a leading doctor has warned.

Dr David Chung, head of the Royal College of Emergency Medicine Scotland, said worldwide evidence showed attempts to divert people from emergency departments (EDs) to using more appropriate services did not work.

The strategy of telling people not to attend EDs is “almost discriminatory” towards the most deprived in society, who are more likely to go there to seek treatment, he argued.

Scotland’s A&E departments are under scrutiny once again after figures revealed the number of patients waiting for more than 12 hours has hit record levels, with 987 recorded in November.

The target is for 95% of cases to be seen within four hours of arrival, but this was last achieved in July 2017.

Last week Dr Chung warned hitting this would be “virtually impossible” to achieve without a massive boost to social care.

In the second of a two-part interview with healthandcare.scot, he pointed to past efforts to try to reduce A&E attendances, such as the milestone Platt report into casualty services published in 1962.

It recommended changing the name to accident and emergency because it was felt there were too many people using casualty instead of their GP.

The Scottish Government also set a target to reduce attendances at EDs in 2010.

But Dr Chung said: “Worldwide, where people have tried to divert people from EDs, it has not been sustainable if it has succeeded at all – and in the vast majority of cases it hasn’t.

“History would suggest there are about 20% of people attending EDs who could be treated somewhere else within the health service.

“This is normal, just live with it – don’t waste energy and resources trying to stop them coming, work out how best if they do arrive, and could you put them somewhere better on site?”

Dr Chung said evidence pointed to deprivation and proximity as being the biggest influences on people going to A&Es.

Attendance by people living in the most deprived areas, who are likely to spend the last 20 years of their life in ill-health, is double the expected rate.

In contrast the wealthiest in society, who live longer and in better health, attend ED around half as much as expected.

Dr Chung said: “I would say as austerity bites and people’s lives are getting harder, they are more likely to come to the ED.

“Life trauma does affect how people use services, they have a greater need for services and they are less able to cope if you leave them to their own devices, which is not their fault.”

He added: “We are talking about the most deprived sections of society, the most vulnerable sections of society – a strategy telling these people of just not coming to the emergency department is almost discriminatory.

“It is saying you may be poor, you may have problems, but it is your own fault, don’t come to the emergency department.”

He said the winter campaigns which try to encourage patients to think about whether they need to attend A&E were “not wrong as a concept”.

But he added: “Where is the evidence such measures work? I would be concerned that it diverts attention from problems with capacity, which affect things much more.

“There is no reason you could have them as long as you address the capacity issues – often in the community, as well as hospital beds.

“Having such a campaign to mitigate for reductions in capacity is doomed to fail.”