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My attention was drawn to this article as starting from December, I will be commencing a four-month rotation in the accident and emergency department of a pilot hospital in Portsmouth. I currently work in public health and with information pertaining to coronavirus and the potential of this trial having a large impact on my practice, I will reflect further in the paragraphs below.
Previous research indicated that 10%-30% of A&E admissions could be managed in primary care (1). In addition to this, The Royal College of Emergency Medicine has found that 15% of A&E admissions could be managed in community medical facilities if available within a 24-hour period, rising to 22% if primary care services are co-located (2).
In this trial, people will be urged to book appointments through 111 as re-directing patients to the most clinically appropriate location will aim to reduce pressures on A&E and help decrease the risk of any infectious transmission. This being said, A&E admissions during April 2020 were down 56.6% compared with the previous year in our statistically worst month for coronavirus mortality so far this year in England (3, 4).
The NHS 111 trial has the potential to significantly reduce A&E constraints. Although, I do wonder if the funding may also be useful if integrated in other areas. For example, improving accessibility to primary care by increasing co-located primary care facilities as lack of access to GP appointments consequently leads to an increase in A&E admissions (5, 6). In addition, increasing the funding to specialist teams who deal with particular presentations would help reduce the burden on A&E via services such as liaison mental health who could deal with up to 5% of attendances (7).
It is important that this programme does not hinder the access to care of the elderly and vulnerable. People with life threatening emergencies will be urged to call 999. Those who do not book a 111 appointment will still be able to attend A&E but may be warned that their waiting time could be longer.
I believe a significant factor for a successful outcome of this trial is rooted in a timely and clear communication to the public and their understanding of the process. The ‘Help Us Help You’ campaign set out by NHS and Public Health England is vital to ensure patients call 111 for triage and gain access to the appropriate services (8).
In summary, coronavirus has brought about many changes in our medical practice. Expanding on the work of NHS 111 throughout this period can be a positive addition to improving contact with the correct services and medical care, furthermore, reducing pressures on A&E. It will be interesting to monitor and review the outcomes from the pilot centres and see if this, possibly with some adjustments, can be later be rolled out on a national level.
References:
1. Carson, D., Clay, H. and Stern, R., 2010. Primary Care And Emergency Departments. [online] Primarycarefoundation.co.uk. Available at: [Accessed 21 September 2020].
2. Rcem.ac.uk. 2015. Time To Act – Urgent Care And A&E: The Patient Perspective. [online] Available at: [Accessed 21 September 2020].
3. England.nhs.uk. 2020. A&E Attendances And Emergency Admissions April 2020 Statistical Commentary. [online] Available at: [Accessed 21 September 2020].
4. Fingertips.phe.org.uk. 2020. Excess Mortality In England, Week Ending 04 September 2020. [online] Available at: [Accessed 21 September 2020].
5. Bonciani, M., Schäfer, W., Barsanti, S., Heinemann, S. and Groenewegen, P., 2020. The Benefits Of Co-Location In Primary Care Practices: The Perspectives Of General Practitioners And Patients In 34 Countries. [online] BMC Health Services Research. Available at: [Accessed 21 September 2020].
6. Cowling, T., Cecil, E., Soljak, M., Lee, J., Millett, C., Majeed, A., Wachter, R. and Harris, M., 2020. Access To Primary Care And Visits To Emergency Departments In England: A Cross-Sectional, Population-Based Study. [online] Available at: [Accessed 21 September 2020].
7. England.nhs.uk. 2020. Transforming Urgent And Emergency Care Services In England. [online] Available at: [Accessed 21 September 2020].
8. Campaignresources.phe.gov.uk. 2020. Help Us Help You [Overview]. [online] Available at: [Accessed 21 September 2020].
Re: A&Es get funding boost as NHS 111 trials booking patients for urgent care
Dear Editor
My attention was drawn to this article as starting from December, I will be commencing a four-month rotation in the accident and emergency department of a pilot hospital in Portsmouth. I currently work in public health and with information pertaining to coronavirus and the potential of this trial having a large impact on my practice, I will reflect further in the paragraphs below.
Previous research indicated that 10%-30% of A&E admissions could be managed in primary care (1). In addition to this, The Royal College of Emergency Medicine has found that 15% of A&E admissions could be managed in community medical facilities if available within a 24-hour period, rising to 22% if primary care services are co-located (2).
In this trial, people will be urged to book appointments through 111 as re-directing patients to the most clinically appropriate location will aim to reduce pressures on A&E and help decrease the risk of any infectious transmission. This being said, A&E admissions during April 2020 were down 56.6% compared with the previous year in our statistically worst month for coronavirus mortality so far this year in England (3, 4).
The NHS 111 trial has the potential to significantly reduce A&E constraints. Although, I do wonder if the funding may also be useful if integrated in other areas. For example, improving accessibility to primary care by increasing co-located primary care facilities as lack of access to GP appointments consequently leads to an increase in A&E admissions (5, 6). In addition, increasing the funding to specialist teams who deal with particular presentations would help reduce the burden on A&E via services such as liaison mental health who could deal with up to 5% of attendances (7).
It is important that this programme does not hinder the access to care of the elderly and vulnerable. People with life threatening emergencies will be urged to call 999. Those who do not book a 111 appointment will still be able to attend A&E but may be warned that their waiting time could be longer.
I believe a significant factor for a successful outcome of this trial is rooted in a timely and clear communication to the public and their understanding of the process. The ‘Help Us Help You’ campaign set out by NHS and Public Health England is vital to ensure patients call 111 for triage and gain access to the appropriate services (8).
In summary, coronavirus has brought about many changes in our medical practice. Expanding on the work of NHS 111 throughout this period can be a positive addition to improving contact with the correct services and medical care, furthermore, reducing pressures on A&E. It will be interesting to monitor and review the outcomes from the pilot centres and see if this, possibly with some adjustments, can be later be rolled out on a national level.
References: [Accessed 21 September 2020]. [Accessed 21 September 2020]. [Accessed 21 September 2020]. [Accessed 21 September 2020]. [Accessed 21 September 2020]. [Accessed 21 September 2020]. [Accessed 21 September 2020]. [Accessed 21 September 2020].
1. Carson, D., Clay, H. and Stern, R., 2010. Primary Care And Emergency Departments. [online] Primarycarefoundation.co.uk. Available at:
2. Rcem.ac.uk. 2015. Time To Act – Urgent Care And A&E: The Patient Perspective. [online] Available at:
3. England.nhs.uk. 2020. A&E Attendances And Emergency Admissions April 2020 Statistical Commentary. [online] Available at:
4. Fingertips.phe.org.uk. 2020. Excess Mortality In England, Week Ending 04 September 2020. [online] Available at:
5. Bonciani, M., Schäfer, W., Barsanti, S., Heinemann, S. and Groenewegen, P., 2020. The Benefits Of Co-Location In Primary Care Practices: The Perspectives Of General Practitioners And Patients In 34 Countries. [online] BMC Health Services Research. Available at:
6. Cowling, T., Cecil, E., Soljak, M., Lee, J., Millett, C., Majeed, A., Wachter, R. and Harris, M., 2020. Access To Primary Care And Visits To Emergency Departments In England: A Cross-Sectional, Population-Based Study. [online] Available at:
7. England.nhs.uk. 2020. Transforming Urgent And Emergency Care Services In England. [online] Available at:
8. Campaignresources.phe.gov.uk. 2020. Help Us Help You [Overview]. [online] Available at:
Competing interests: No competing interests