We are seeing an increasing number of people ‘walking’ in to Accident and Emergency Departments without going through NHS111. NHS111 is the best way to get the right service quickly.

Dr Andrew Phillips, GP and Clinical Lead for the Humber, Coast and Vale Health and Care Partnership’s Urgent and Emergency Care Network

Demand for urgent care services remains high in Humber, Coast and Vale (HCV), despite the significant reduction in the rate of Covid infections in our region. The impressive vaccination programme and the lockdown have helped to reduce the number of people catching respiratory infections over the winter and spring.

Nevertheless, pressures remain in demand for Primary Care services, Ambulance Services and the Emergency Departments (EDs). The vast majority of people are using the NHS111 number as the first contact, which is the best way to get the right service quickly.

HCV has put in place new pathways from NHS111 calls and NHS111 online that ensure that the people booked in to attend an ED need to go there. This is helping reduce the number of ED attendances and helping hospitals manage their physical capacity.

As lockdown starts to ease we see an increasing number of people ‘walking’ in to EDs without going through NHS 111. These walk-in patients run the risk of longer waits until they are assessed, directed or streamed into the right services for their need, but it also increases their (and others) danger of infection in the waiting room areas.

Patients who need to attend an ED and use NHS 111 first will be seen by a clinician who has prior information about them and should result in a safer and quicker visit.

In the urgent and emergency care network we continue to build on the improvements in connectivity, quality and efficiency made in the last 12 months. We seek to help our patients make the clever choice, which is to use 111 first.

Since December 2020 we have put in place a local Clinical Assessment Service (CAS) that supports people who have called 111 to have a virtual clinical assessment to determine the right pathway for their needs. This builds on the CAS service offered by the 111 provider themselves.

Since December we have seen a shift of activity away from A&E for people that use the 111 service into alternative pathways appropriate for their needs. In September 2020 4,440 people were referred to the ED via 111 and in February 21 this had reduced to 2895. Similarly, clinical assessments had increased from 30% for people calling 111 to 41% over the same time-period. (Source Directory of Service (DOS) data).

In addition, following a review of Urgent Treatment Centres (UTC) last year and an increase in profile of UTCs on the DOS we have seen activity increasingly referred to UTCs as an alternative to A&E from 111, when it is appropriate to do so. Further work is underway to expand the remit of UTCs to increase the amount of work they can do as appropriate alternative to A&E.

From December we also now have in place in all our EDs booked arrival slots for people that have called 111 first and need to be seen in an ED.

In February we started a targeted communication campaign as numbers started to increase in walk-ins in the ED. This included putting banners and posters in A&E and UTCs reminding people of the option to call 111 First, as well as social media campaigns targeted at 18-40 year olds and newspaper campaigns targeted at the 50-65 year olds advising people to call 111 first.

We are currently assessing the data to understand the success of this campaign. However we would ask that all staff remind patients of the advantages of using 111 first, so we can ensure that their care will be appropriate to their needs, rather than walking in to A&E, where they may experience long waits and expose themselves and others to the risk of infection.

Rebecca Hassack

Author Rebecca Hassack

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