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A&E figures reach record highs as ambulance trusts warn of effects of NHS 111

A&E attendances in July were the highest since records began, with several ambulance trusts claiming that NHS 111 has added ‘pressures’ on them.

The official weekly A&E data showed that there has been a 4.5% increase in weekly attendances to A&E during the first four weeks in July, compared with the previous four weeks.

Some 296,618 people attended A&E the week ending 14 July – the highest weekly total since records began in November 2010 – and 295,927 attending the following week, the second highest weekly total of the year.

This comes as the Prime Minister announced that an additional £500 million will go to A&E departments identified as being under the most pressure and ‘pinch points’ in local services over the next two years.

Ambulance trusts have expressed concerns about the effect of the rollout of NHS 111, with one saying it had resulted in a higher proportion of calls being classified as ‘urgent’, contradicting NHS England claims that the new urgent care phoneline is not having an impact on emergency services.

The South West Ambulance Service’s integrated corporate performance report, issued on 17 July, suggested that ambulance trusts were coming under increasing pressure.

It stated: ‘The introduction of the NHS 111 service to handle calls has resulted in a higher proportion of calls being classified as “urgent” and as a result has increased pressure in the [urgent care services].’

It added that the number of calls transferred from providers ‘is higher than forecast and consistently above contracted KPI levels’, while the conveyance rate – the number of ambulance call outs that result in an A&E attendance – for NHS 111 calls was ‘comparatively low.’

In the East Midlands, minutes from its 3 June meeting quoted their chief executive Phil Milligan who said CCGs were working to address issues with local providers in Northhampton.

It added: ‘It was noted that while call volumes had remained consistent within EMAS, there had been a high number of 111 calls where, on assessment, referral to EMAS by the 111 provider appeared to be inappropriate.’

A spokesperson for Derbyshire Health United, which runs the service, denied that the referrals were inappropriate in the region, saying: ‘EMAS is a pan East Midlands ambulance service. If it is reporting anomalies internally in just one of the counties then it suggests that the reporting itself is anomalous.’

Harmoni, which runs NHS 111 in the South West, said: ‘Nationally, despatch levels have returned to normal levels after a temporary increase in all areas, regardless of provider, when the NHS 111 rollout started.’

But Dr Peter Holden, a GPC negotiator, said: ‘You only have to look at the Sheffield University report to know this would happen. These minutes confirm what we already know and what the DH is denying.’

An NHS England spokesperson said: ‘We know there have been some concerns about ambulances being dispatched inappropriately, often in the early days as call handlers get more used to the system.  The independent evaluation of NHS 111 pilots, by the University of Sheffield, noted that dispositions from NHS 111 are clinically appropriate.  However there is no evidence that 111 is increasing demand on 999.  The latest Ambulance Quality Indicators: show that emergency calls to the ambulance service are falling and are significantly lower than the same period last year.’

Prime Minister David Cameron said: ‘With over a million more people visiting A&E in the last three years, services and staff can find themselves under pressure during the busier winter period. While A&E departments are performing well this summer and at a level we would expect for this time of year, I want the NHS to take action now to prepare for the coming winter.’