At the start of the Covid-19 pandemic, A&E attendances fell to record lows, while calls to NHS 111 reached record highs. As A&E attendances began to increase, concerns were raised that overcrowding in emergency departments could spread Covid-19. Pilots began of a ‘call-first’ model in the summer of 2020, where patients with an urgent medical need call NHS 111 and those recommended to go to A&E are given a booked time slot to attend. With pressure on urgent care services growing, is this initiative helping?
Nationally, the percentage of A&E attendances that are booked remains low – increasing from 1.2% in August 2020 to only 4.2% last month. Moreover, not all trusts are reporting booked attendances and there is considerable variation between A&E department types.
Use of booked appointments is lower in major A&E departments (consultant-led departments with resuscitation facilities), where concerns about overcrowding are greatest, than in minor A&E departments (doctor- or nurse-led departments that treat minor injuries and illnesses). Last month, one in three minor departments reported that over 5% of attendances were booked, and 8% had over half of attendances booked. This compares to only one in five major departments with over 5% of attendances that were booked, and no major departments with over half of attendances booked.
New guidance outlines plans to maximise the use of booked time slots in A&E, with the aim that at least 70% of patients recommended to attend A&E by NHS 111 receive a booked time slot. While patients who have had a booked appointment are largely satisfied with their experience, awareness of the service remains low and clinicians have called for a full evaluation of the model.
An effective call-first system can ensure patients access care in the right place at the right time, easing pressure on the urgent care system. Increasing uptake requires improved public awareness, as well as assurance that the system is safe and clinically effective. The slow growth of booked appointments so far suggests it will be a while before the model makes a difference to overcrowding in A&E departments.