Patients who turn up at A&E with non-urgent ailments could be told to come back another time under NHS plans to stop hospitals becoming overcrowded and avoid the service’s usual winter crisis.
Eighteen hospitals in England are already using “digital triage assessment” to help A&E staff decide which patients need to be seen right away or be dealt with in another way. If patients do need urgent care they are treated at once in the usual way. But if they have more minor ailments and can wait, they are told to come back later that day or the next day, or are referred to a community-based service, such as a GP or pharmacy.
Jim Mackey, NHS England’s chief executive, on Wednesday urged all hospitals to implement what it calls a “hi-tech concierge service” to prevent A&Es becoming overwhelmed.
Patients would see “really big change ahead from us in the next few months” in how urgent and emergency services were run, Mackey told an audience of health service leaders at the NHS ConfedExpo conference in Manchester. Using many more bookable appointments, so that patients no longer faced long delays to access care, was “a personal obsession of mine”, he said.
Jim Mackey, chief executive of NHS England. Photograph: PA Images/Alamy
A switch to more bookable slots would help “bring more order” to services that were frequently overwhelmed with demand, especially during the winter, he said.
The Royal College of Emergency Medicine, which represents A&E doctors, disclosed earlier this week that more than 1,300 patients a month die as a result of overcrowding in A&E units in England.
With “digital triage”, patients put the details of their illness into online hospital information gathering systems when they arrived at an emergency department. That helped A&E staff to assess their condition and decide the best way to manage them.
East Lancashire teaching hospitals NHS trust had found that the triage tool helped to almost halve average waiting times for A&E patients, from 178 minutes to 94 minutes, NHS England said.
“The new approach is designed to end the uncertainty of not knowing how long you’ll be expected to wait while ensuring ED [emergency department] doctors can focus on those who need urgent treatment most,” it said.
Mackey urged all NHS trusts to follow the lead of the 18 hospitals using the tool. Patients who did not receive A&E care when they attended could also be given an appointment with a physiotherapist, or mental health services, or at a same-day emergency care unit.
“The big prize for this coming winter is shifting to introducing many more appointments into urgent care,” he added. A combination of booked appointments and digital triage in A&E could have an “enormous” beneficial impact on patients and staff.
NHS England could not say how many patients at the 18 hospitals using this approach were told to come back at another time. But it said the change had gone down well with patients.
“Generally having a better sense of when you’ll be seen, and getting booked into the right service more quickly, is positive and, for example, at East Lancashire, trialling the tech has brought waiting times in ED down by nearly half,” a source said.
Rachel Power, the chief executive of the Patients Association, cautioned that “digital triage assessment” may not suit all patients.
“As digital triage rolls out more widely, it must work for all patients, not just the digitally confident. Older patients, those with disabilities, and people with limited digital access must never be disadvantaged because they couldn’t use a kiosk or a tablet,” she said.
“And any patient who is redirected or given a later appointment slot needs explicit, easy-to-understand information about what to do if their condition deteriorates, who to call, where to go, and how quickly to act.
“Without that safety netting, vulnerable patients risk falling through the cracks. The ambition is right but patients and their experience must be at the centre of how these reforms are designed and delivered, not just the beneficiaries of them.”
