NHS Expands At-Home A&E Service to More Hospitals Amid Record Wait Times
A pioneering NHS service that delivers emergency A&E care directly to patients' homes is set for a significant expansion across more hospitals. This innovative initiative, known as the Physician Response Unit, aims to alleviate the severe overcrowding and lengthy wait times plaguing traditional emergency departments.
Two Decades of Success at Royal London Hospital
Launched over twenty years ago at the Royal London Hospital, the Physician Response Unit has proven highly effective, saving thousands of patients annually from the distress of prolonged waits and corridor care in A&E. Instead of traveling to a hospital, patients call 999 and receive hospital-standard medical attention from the comfort of their own beds.
Barts NHS Trust, which operates the Royal London, is poised to formally adopt this initiative at additional sites next month, with other NHS trusts expressing keen interest in following suit. This expansion comes in response to alarming NHS figures revealing that 71,000 patients were forced to wait on trolleys for over twelve hours in January 2026—the worst month since records began in 2010.
How the Physician Response Unit Operates
The Royal London's PRU service deploys three teams, each consisting of an A&E doctor and an ambulance crew member. These teams visit approximately six homes per day, equipped with rapid-response vehicles stocked with medical gear to handle a wide range of emergencies, from cardiac arrests to catheter replacements.
In 2025 alone, the service successfully treated 2,550 patients in their homes, keeping them out of hospital. The majority of calls are Category Two emergencies, which would typically require blue-light ambulance transport to hospital for tests. However, patients with immediately life-threatening conditions or acute psychiatric emergencies must still be seen in a hospital setting.
Personalised Care and Key Insights
Medics working on the PRU teams emphasize that providing care on the road allows for more personalised attention. One doctor noted, "In A&E, you would never have just one patient at a time. When you're in A&E, because it's so busy, you're firefighting—you don't spend as long with people as you'd like."
Another medic highlighted the advantages of visiting patients' homes, stating, "I always look in somebody's fridge—is there milk? Is the milk fresh? You can tell how much contact they have with the outside world, and if they have family support." This approach not only improves care but also helps identify broader social and health needs.
Addressing a Crisis in Emergency Care
The rollout of this service coincides with damning NHS performance data. In January 2026, only 72.5% of patients were admitted, discharged, or transferred within four hours—the lowest rate since December 2024. Additionally, analysis by Age UK found over 100,000 instances of patients aged 65 and older waiting between one and three days in A&E during the 2024/25 financial year.
Patient David, 77, who endured a 30-hour wait in A&E, described his experience as "horrendous," recounting how he was left on the floor with no treatment or checks. Such stories underscore the urgent need for alternatives like the Physician Response Unit.
In the 2024/25 financial year, England saw 27.4 million A&E visits, including around 17 million to major departments and 10.8 million to minor units. Dr. Alex Alexiou, a consultant involved in the PRU programme, warned, "Hospitals aren't safe places. If you come to hospital, especially if you're elderly, you lose your muscle mass, your mobility, your independence, you catch infections, and you probably leave the hospital in a worse off state."
As the NHS grapples with unprecedented demand and record wait times, the expansion of at-home A&E care represents a critical step toward more efficient and patient-centred emergency services.
