Londoners told to book a time slot at A&E instead of just turning up in bid to limit coronavirus infections
Sick Londoners were today urged to book a time slot at A&E rather than turning up at hospital unannounced as part of a NHS revolution in urgent care.
Health chiefs want to avoid patients with non-emergency conditions having to wait for hours in waiting rooms, especially to minimise the risk of contracting Covid-19.
But they said the four-hour A&E target would still apply – and insisted that patients who failed to book ahead would not be disadvantaged.
Patients will be urged to call the NHS 111 non-emergency helpline to arrange an A&E appointment. People who need immediate emergency care should continue to call 999 for an ambulance.
The new “111 First” system, currently being trialled by six London A&Es, will be rolled out to all 27 emergency departments in the capital by December 1.
Most hospitals have already split their A&Es in two to ensure suspected covid-positive patients do not come into contact with other patients. However space in waiting rooms is limited due to the need to maintain social distancing.
Dr Vin Diwakar, medical director for the NHS in London, said: “The NHS has put in place extra measures to prevent the spread of Covid-19 and we want to reassure patients that it is safe to come in for treatment. However, the risk of catching Covid-19 is still here and it’s vital that we take additional steps to keep our patients and staff safe.
“General Practice is open to deal with patients with normal primary care needs, but it is essential that anyone who requires urgent, although not life-threatening treatment, contacts NHS 111 first to get the right care.”
Different schemes are being trialled across the capital. At the Royal London, in Whitechapel, patients calling 111 may first be given a time for a video call at home with a A&E doctor. This could avoid the need to enter the emergency department and could result in the patient being sent straight for a scan.
What's the situation at each London hospital?
The hospitals currently asking patients to call NHS 111 for urgent care appointments are: Royal London, Croydon, North Middlesex, Chelsea and Westminster, Queen Elizabeth Woolwich, Barnet.
The hospitals switching by October 31 are: Newham, Whipps Cross, Homerton, St Thomas’, Princess Royal, Kings College, Royal Free, Kingston, St Helier, St George’s, Northwick Park, Ealing, West Middlesex.
The hospitals switching by December 1 are: Queen’s, King George, Lewisham, UCLH, Whittington, Hillingdon, Charing Cross, St Mary’s.
At North Middlesex, Barnet, Chelsea and Westminster and Croydon hospitals, a time is given for a face-to-face meeting with an A&E doctor.
At Queen Elizabeth in Woolwich, the appointment is with a GP at the hospital’s urgent care centre.
Research is being done to determine the system that is best at getting the right care to patients as quickly as possible.
“Those type of models are going to revolutionise emergency care because it means you have the potential to take the waiting room away altogether,” Dr Diwakar said.
A publicity campaign is planned to inform patients of the changes. Trials elsewhere in the country have had limited effect so far. Last month, only 23,505 of 1.6 million attendances in England were by appointment – 0.01 per cent.
Patients will be given an arrival time but the appointment is not time-limited. Depending on capacity, appointments may not be at the nearest hospital.
Pre-pandemic, about one in five A&E patients who turned up at A&E could have been treated more swiftly if they had sought help elsewhere, such as at a GP or walk-in clinic.
It is likely that by asking patients to call 111 first, many will be told that they do not need to attend an A&E to receive the correct care. At present, only about 10 per cent of all calls to 111 result in a referral to A&E.
The NHS 111 service in London, which employs 2,500 staff, will be expanded by 644 posts, including 166 more doctors, nurses, pharmacists and paramedics.
Dr Diwakar said A&Es would have separate teams dealing with appointments and unplanned arrivals.
“If you do walk in, you will still be seen in the normal way,” he said. “There is no disadvantage to anybody who does choose to just walk into an emergency department.
“But we are strongly encouraging the public if they have an urgent need that is not an emergency to ring 111 first. Then, particularly from December 1, you will get a time slot, and that will reduce the amount of time you have got to sit in a waiting room.”
He added: “I think this is the way we would like to see A&E departments work in the future. The ultimate goal is to have a model of this type for the whole country. We certainly would like to have much smaller waiting rooms.”
Dr Katherine Henderson, president of the Royal College of Emergency Medicine and an emergency consultant at St Thomas’ hospital, said: “It’s now more important than ever that patients receive the care most appropriate to their needs, and expansion of 111 First will help enable that.”
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