The National Health Service (NHS) in England is planning to ask patients with non-urgent conditions who visit accident and emergency (A&E) departments to come back at a later time. This initiative aims to prevent hospitals from becoming overcrowded and to avoid the typical winter crisis that the service faces.
Digital Triage Implementation
Eighteen hospitals in England are already using a process called "digital triage assessment" to help A&E staff determine which patients require immediate attention and which can be managed differently. Patients who need urgent care are treated immediately as usual. However, those with minor ailments who can wait are asked to return later that day or the next day, or are referred to community-based services such as a GP or pharmacy.
Jim Mackey, the chief executive of NHS England, urged all hospitals on Wednesday to adopt what he described as a "hi-tech concierge service" to prevent A&E departments from becoming overwhelmed. Speaking at the NHS ConfedExpo conference in Manchester, Mackey emphasized that patients will see "really big change ahead from us in the next few months" in how urgent and emergency services are managed. He described increasing the use of bookable appointments as "a personal obsession of mine."
Benefits of Bookable Appointments
Mackey noted that shifting to more bookable slots would help "bring more order" to services that are frequently overwhelmed with demand, particularly during the winter months. This comes after the Royal College of Emergency Medicine disclosed earlier this week that over 1,300 patients die each month in England due to overcrowding in A&E units.
With digital triage, patients enter details of their illness into online hospital information systems upon arrival at an emergency department. This helps A&E staff assess their condition and decide the best course of action. According to NHS England, East Lancashire Teaching Hospitals NHS Trust found that the triage tool helped reduce average waiting times for A&E patients by nearly half, from 178 minutes to 94 minutes.
"The new approach is designed to end the uncertainty of not knowing how long you’ll be expected to wait while ensuring ED doctors can focus on those who need urgent treatment most," NHS England stated.
Expanding the Initiative
Mackey urged all NHS trusts to follow the example of the 18 hospitals already using the tool. Patients who do not receive A&E care when they attend could also be given an appointment with a physiotherapist, mental health services, or 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 both patients and staff.
NHS England could not provide data on how many patients at the 18 hospitals were asked to return at another time. However, it stated that the change has been well received by 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.
Patient Advocacy Concerns
Rachel Power, chief executive of the Patients Association, cautioned that digital triage 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."
