This site is intended for health professionals only

At the heart of general practice since 1960

pul jul aug2020 cover 80x101px
Read the latest issue online

Independents' Day

Patients to be encouraged to pre-book A&E appointments by December

NHS England wants patients to book into a slot via NHS 111 before attending A&E this winter, but will not stop patients from turning up without calling ahead.

All A&E providers across England are to implement a ‘minimum specification’ of the ‘NHS 111 first’ model by December 2020, NHS England said.

In its latest board papers, NHS England revealed details of its plans for ‘transforming access’ to urgent and emergency care services through the model - which would see 111 services triage patients before they attend A&E. 

The papers said: ‘Early mover systems – one in each region – will be the first to trial some of these innovations. An early, formal evaluation of the impact on services within the early mover geographies has been commissioned for September. 

‘The ambition [is] then that all systems will have implemented a minimum specification of the model by the first December 2020.’

The papers reiterated that patients will still be able to choose to attend A&E without going through the ‘111 first’ service, but said the model is ‘proving popular in trials’.

They said: ‘The central premise of NHS 111 First is that the offer to patients must be an improvement on the status quo, enhancing patient experience and quality of care.’

NHS England said it is increasing the ‘capacity, productivity and utility’ of existing 111 services through:

  • Investment in clinical capacity within local Clinical Assessment Services. 
  • Investment in NHS 111 call handling capacity. 
  • Improved profiling of all local services on the national Directory of Service. 
  • Establishing NHS 111 to ED referral processes. 
  • Development of processes and IT to stream low acuity patients to alternative non-ED settings. 
  • Local patient communications and engagement. 

NHS England is also looking at ‘development’ of the national Covid clinical assessment service (CCAS), the papers said.

Meanwhile, NHS England added that it will launch a campaign to encourage use of the model and create a ‘new social norm’.

It said: ‘We are now developing a campaign to encourage people to use 111 First, before they walk into an ED. 

‘This pairs developments in the NHS 111 service, such as booking into an ED time slot, which will be available across the country from December, with a national, regional and local communication push through public and stakeholder messaging.’

The campaign, which will feed into the annual ‘winter pressures’ campaign, is planned to go live in December, NHS England said.

It added: ‘This year Covid-19 could significantly worsen winter pressures and the ability of the NHS to safely manage demand.’

Earlier this month, plans for pilots of the 111-first model were first revealed - three years after Pulse reported that NHS England and the Government had been in talks about such pilots.

NHS England confirmed to Pulse two weeks ago that the pilots were set to expand, with the ambition that all NHS 111 services in England would roll out the model by this winter.

Meanwhile, the Welsh Government has said it wants to roll out a call-before-you-walk A&E model across the country, following pilots.

Pulse voluntary donation scheme

Since the outbreak of this pandemic, Pulse has strived to support you, whether it be through our resources page, our ‘Clinical Crises’ series, holding policymakers to account with exclusives such as practices being supplied with faulty masks, or GPs being told to stop routine services in the hardest hit areas.

However, good journalism cannot be done on the cheap and, like the whole publishing industry, we have been affected by the economic slowdown. We also strongly believe the content we produce should remain free as we feel it is essential for you. Because of this, we have set up a voluntary donation scheme. There is no compulsion whatsoever to donate. But if you feel we are helping you, and you would like to support us, anything you can spare would be greatly appreciated. Read more here.

Donate here

Readers' comments (14)

  • I can see the NHS 111 reports now. "I've stubbed my toe, my pain level is 10" - Emergency ambulance response. "I've severed an artery and am feeling a bit fai......" - To contact primary care provider within 24 hours

    Unsuitable or offensive? Report this comment

  • It’s just a way to redirect patients into general practice. Now that hospitals are being moved into block contracts they want to see as few patients as possible because they get the same money anyway. Where to dump the extra workload? GP obviously. CCAS has been a Trojan Horse for this. Will the extra workload be acknowledged or funded? Guess.

    Unsuitable or offensive? Report this comment

  • Vinci Ho

    (1)The political reality is we all know now the original plan came way back from the era of Agent Hunt ( thanks to Pulse) . Now it is ‘no better time’ to impose because of the bestowed ‘command and control’ power on NHS England .
    NHS 111 was a baby raised by the party running this government. They certainly wants the service to stand firmly on ground given the circumstances and opportunities.
    (2)As I wrote before , it would only be justified and logical if the service is to absorb more GP colleagues ( particularly those losing working opportunities during first wave of Covid 19) to provide first contact triaging.
    (3)Yes , for the rest of us(GPs) , the threat of more workload coming our way without new resources is imminent

    Unsuitable or offensive? Report this comment

  • Are NHS 111 good enough to telephone triage potential A&E patients?

    Unsuitable or offensive? Report this comment

  • This will create a lot of triage work for 111 & increase demand for OOH GP’s. There is not the recruitment, investment or man power to deliver this safely. During the Covid 19 peak patients were waiting up to 48hrs for a call back. Sadly with this approach I suspect patients will suffer avoidable deaths if they rely on such an under resourced & flawed system.

    Unsuitable or offensive? Report this comment

  • doctordog.

    We do not run an emergency care service.
    A&E appropriate cases will still be directed to A&E.

    Unsuitable or offensive? Report this comment

  • Tantalus

    So patients must book ahead.....unless they don’t want to, and that’s fine !

    Unsuitable or offensive? Report this comment

  • So 111 can’t still book directly into our GP slots which we have made available to them as they haven’t turned it on at their end. What could possibly go wrong with booking patients directly into. A&E?

    Unsuitable or offensive? Report this comment

  • Absolute b*llocks!
    By definition A&E is primarily for accidents and emergencies; not anything that is planned, and normally for things that warrant urgent assessment.
    Granted, the system is abused a little by patients with non urgent problems compounded by access difficulties elsewhere (primarily caused by lack of funding), but this change will only add costs and bureaucracy to A&E/111.
    The question is what is the ultimate purpose of this "transforming access"?
    It's likely to be enforced rationing and control of care provided, most probably to make to service more attractive for USA private takeover.
    "Transforming" implies nothing to do with improvement of healthcare provision - that's just spin for the public.

    Unsuitable or offensive? Report this comment

  • Gatekeeping true emergency care remotely is an absolute disaster waiting to happen. Most A&E's triage with the most experienced nurses/doctors, as clapping eyes on the patient can then determine whether appropriate or not. First Wales, now England...hoping Scotland doesn't follow suit.

    Unsuitable or offensive? Report this comment

View results 10 results per page20 results per page

Have your say