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A faulty production line

Revealed: NHS's plans to bar patients from attending A&E without a referral

Exclusive NHS England is considering pilots to stop walk-in patients attending A&E departments, requiring them to be referred by a GP or NHS 111.

Dr Helen Thomas, national medical advisor for integrated urgent care at NHS England, said NHS England ‘may well pilot’ a 'talk before you walk' scheme that requires all patients - unless they come via ambulance - to be referred or speak with a GP or other clinician before attending A&E.

She suggested that the talks have involved the health secretary at some level, but added that they were at an early stage.

It is an attempt to reduce demand that is threatening to engulf secondary care and emergency care services this winter.

Pulse has already reported that patients are having to wait 13 hours to be seen at A&E, while other hospitals are having to enlist GPs to help them reduce their waiting lists for referrals and others have sent patients out of county for certain specialties.

This latest suggestion, however, would stop patients from attending A&E without a referral from elsewhere.

Dr Thomas said: ‘[Health secretary] Jeremy Hunt has mentioned to some of my colleagues, maybe we should have a "talk before you walk" and we may well pilot that. 

‘I think it’s been done in other countries where they’ve actually said you can’t come into ED until you’ve talked on referral or you have to have that sort of docket that you’re given by having talked on the phone that you do need to come to ED.’

Dr Thomas added that while piloting such a scheme would be a political ‘hot potato’, a pilot in just one area would yield ‘some really interesting information’.

Speaking at the Urgent Health UK conference to out-of-hours providers on the future of urgent care in the wider NHS, she said that out of 100 patients that come to A&E ‘only 20 have called 111’.

She said: ‘So I think that other 80 – there is opportunity there. Some of them will need ED but there’s an awful lot that won’t.’ 

Speaking to Pulse, Dr Thomas said that the discussions of a pilot are in the early stages and admitted that ‘it’s going to be tricky to do it’.

She said at the conference: ‘The difficulty is we have to then have an alternative solution other than A&E within four hours and that might put pressure on out-of-hour provision, that you would have to see this patient within four hours and there is some thought about that within NHS England to ask you to do that.’

Dr Simon Abrams, chair of Urgent Health UK, which represents out-of-hours  said that while the pilot will 'inevitably' put more pressure on out of hours services, he said it is an 'interesting proposal' that has the potential to provide better care for patients.

He said: 'It might reduce the workloads of A&E departments, which on the whole is staffed by very junior doctors and if you can put a slightly more senior doctor over the telephone to that patient, maybe you can provide better care.'

He added: 'So much of what is happening now is about getting the right clinician and the right care for the problem that the patient is presenting.'

But Dr Abrams said the idea 'needs a lot of thinking through', adding that 'whether it will be acceptable either to a political party or to patients, I don't know'.

The Department of Health and NHS England both denied the story. Click here for their full comments.

How secondary care services are already beginning to struggle

Patients in Margate faced waits of up to 13 hours to be seen at the A&E department at Queen Elizabeth The Queen Mother Hospital because of understaffing.

In Cambridgeshire, Addenbrooke's sent a letter to GPs warning its medical decisions unit was 'currently full and there are patients within the emergency department awaiting admission that cannot be placed into inpatient beds due to a lack of bed capacity'.

Meanwhile, NHS England has already launched a scheme to triage patients at the door of A&E, sending some to co-located primary care services.

Pulse has also reported that GPs in Lincolnshire are being asked to consider alternative providers outside of the county for non-urgent ear nose and throat (ENT), cardiology, neurology and dermatology services, while GPs in the north of the county have been asked to review referrals and take on patients to tackle a backlog of 30,000 patients waiting for treatment.


Readers' comments (41)

  • ‘Medical care needs to remain free and accessible at the first point of contact’

    That’s what got us into this mess.

    Communism leads to fears from famine, not capitalism.

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  • I seem to remember Hunt was quite happy to turn up at A and E on a weekend, with one of his children, for a routine condition

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  • Use Hunt's answer: "I can't solve your problems"

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  • Tantalus

    5p for a bag reduced use at supermarkets by 85%.
    £5 to be seen in A&E or GP surgery would likely have a similar result.
    The argument that people would not seek help because of a nominal charge is ridiculous.
    I agree with Big and Small that free at the point of access is the problem.

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  • It will not work. The only way is to charge them.

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  • Vinci Ho

    Somebody needs to clarify whether this is about talking to a GP based in A/E or a GP in community. But based on what Simon(Abrams) said , it was expected to be the latter at least in out of hours.
    Then it is about investing new resources(MMET) , especially expertise(E) in general practice. No new resources, no talk......

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  • if you can solve car parking problem in uk, you will know how to solve demand of nhs. restricting a and e attendance will be met with unbearable demand elsewhere. public will find answer to all restrictions. spend a lot of money in primary care. free service at point of delivery will always be misused no matter what you do.

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  • Vinci Ho

    But one also has to imagine the logistics in reality:a patient turned up the front door of a A/E despite knowing that they need to get a 'permission' . You then had a security guard stopping him/her to go in the building and asked him/her to ring a GP or NHS111????

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  • Utterly beautiful idea as it is insane
    Have they really done the figures on demand, capacity, accessibility, resource and flows....
    At scale....
    I think not

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  • Vinci Ho

    There is a bare minimum of resources to meet a certain level of demands (yes, argument still on needs versus demands).
    All I know is even patients have to be charged for attending A/E in public hospitals in Hong Kong , they are still running at a subscription of over 100% of the capacity (at worst 120%) last year.

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