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Wales moving to nationwide rollout of call-before-you-walk A&Es

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

The ‘CAV 24/7’ phone service will be launched in the Cardiff and Vale University Health Board area this summer as a ‘pathfinder’, with the Government saying that the ‘intent’ is to ‘scale’ the approach across Wales.

Welsh health minister Vaughan Gething said this comes as the Government is ‘committed to ensuring people will only go to a general hospital when that is essential’, with the Covid-19 pandemic having acted ‘as a catalyst’ for testing new approaches to ‘future proof’ health services.

In a ministerial statement issued yesterday, he said: ‘[W]e will work with the public, health boards and their partners to develop a new approach for people who think they may need to access the emergency department but are unsure of where to go.’

Patients will be ‘assessed remotely by a suitably qualified doctor or a nurse’, with ‘people with non-life threatening and non-serious conditions’ set to ‘be able to access clear, professional advice on which service is best suited to meet their needs’.

After this triaging, ‘depending on the severity of the condition’, they may be directly ‘booked in to an appointment in an emergency department if they need further assessment and treatment’. Alternatively they will be ‘encouraged to self-care’ or ‘signposted to a more appropriate service in their local community’.

The statement said this comes as patients are returning to A&E following a slump during the early stages of the Covid-19 pandemic, leading to patients having to queue outside to fulful social distancing requirements in some health board areas.

It also comes as the Royal College of Emergency Medicine (RCEM) and the Royal College of Physicians have ‘expressed concern in recent weeks about the safety of patients and staff, should Emergency Departments become over-crowded’, it added.

Mr Gething said: ‘Crucially, this will help ensure that those with life-threatening and serious complaints are treated immediately within the emergency department to optimise their outcomes.

‘It will also enable people with less severe conditions to safely remain at home and only attend the emergency department if it is necessary for them to do so, and at a time when they can expect to be seen.’

He also added that it will be ‘particularly helpful in protecting people who are at risk, vulnerable or have been shielding, by reducing the time they spend in the department’.

To provide context, the statement added, A&E usage in Wales has increased ‘by around 34% since 2009’, to reach over one million annual presentations.

The Welsh Government said the changes would fit into their wider redesign of urgent and emergency services which also includes:

  • The rollout of a national video consultation service across primary, secondary and community care which has already seen ‘over 15,000 consultations’.
  • A £650,000 investment into a new system to connect primary and community health professionals with specialists for urgent advice.
  • Developing ‘alternative community-based pathways’ with ambulance services to reduce unnecessary admission to hospital for patients with respiratory complaints.
  • Asking health boards to consider ‘necessary changes to the physical environment’ of A&E departments.
  • A £10m investment into a new system to speed up discharge of patients who are ‘ready to leave hospital’.

Mr Gething stressed that the new approach was ‘not intended to prevent people from attending emergency departments, if this is the right service for their clinical need’

‘Access to emergency care services for people with life-threatening or serious conditions will not change, nor will there be any change to how 999 calls for these high priority patients are dealt with,’ he said.

BMA Wales council chair Dr David Bailey said: ‘The Phone First triage service is a sensible approach to combat long waits in A&E departments, allowing people to access the correct care they need and to allow those who really need A&E services to been seen more quickly. 

‘However, it will need to be made clear to patients via signposting where they can access care and not a blanket message of “contact your GP”, to ensure other areas of the NHS don’t become overwhelmed. There is already a huge burden facing primary care and the service would not cope with an influx in patients from A&E. Any permanent changes to services must be done in consultation with the profession.’

He added that the BMA is ‘interested to learn more about how the Phone First service would work alongside the 111 service already in place, or whether this is an extension of this service and understand that this may take time to become routine amongst patients’, adding that ‘consultation with the profession is essential’. 

‘Furthermore, we would like assurances that disadvantaged groups are being considered, for example homeless people or those without access to a telephone, to ensure patients in Wales are receiving the care they need,’ Dr Bailey added.

The news comes as NHS England has confirmed that all NHS 111 services are set to triage A&E patients before winter, although it has yet to release more detail on the plans.

The call-before-you-walk system is currently being piloted in London and Portsmouth, as well as in Cornwall.

This has come three years after Pulse reported that NHS England and the Government had been in talks about such pilots.