Patients calling an ambulance could now be advised to see their GP instead in an effort to improve response times.
According to the BBC, NHS England is asking ambulance crews to review which emergency calls other than those classed as immediately life threatening can be treated elsewhere, including GP surgeries.
It follows ‘successful’ trials in London and across the West Midlands, where nearly half of those receiving a callback were advised to go instead to their GP, an urgent treatment clinic or a pharmacist.
NHS England is now asking the country’s eight other ambulance services to adopt the approach.
Around 40% of calls classed as category two will now receive callbacks from a doctor, nurse or paramedic to investigate the possibility of an ambulance alternative.
NHS England said ambulance services would be expected to move to the new system in the next couple of weeks, but that the roll-out would be kept under review.
Ambulance trusts across the country are struggling to respond to 999 calls on time and figures show more than a quarter of ambulances waited more than an hour to hand patients over at A&E in the final week of 2022 – the highest levels recorded and double the peak from last winter.
NHS England national medical director for urgent care Professor Julian Redhead said: ‘This new system will allow a conversation between a nurse and paramedic or a doctor and the patient – and between them, they’ll be able to decide whether an ambulance is the best response or whether no ambulance is required and they’re better cared for in a different environment.
‘It’s really important that people know it doesn’t mean anyone loses their place in the queue [while they are assessed].
‘What it does is provide more individualised care for a patient but also allows us to free up the resource for our most vulnerable patients, patients who will have had strokes and heart attacks.’
GPs have told Pulse that they have stopped trying to phone ambulances for seriously unwell patients and are now considering ambulances to be a ‘last resort’ option even for very unwell patients.
Over the festive period more than a dozen ambulance services and NHS trusts declared critical incidents. In December, Category 2 ambulance calls – which include strokes or heart attacks – took on average more than an hour and a half against a target of 18 minutes.
The president of the Royal College of Emergency Medicine warned 500 people could be dying each week due to emergency care delays.
It comes as earlier this month GPs in London were again asked to provide clinical cover during ambulance strikes.
What has NHS England said about the trials in London and the West Midlands?
- Over the past few weeks LAS and WMAS have been trialling ‘clinical validation’ for a minority of cat 2 patients. Given the success of the trials so far, we are now expanding this to all ambulance trusts, as outlined in the UEC recovery plan.
- This means the NHS is boosting the number of clinicians in ambulance control rooms, with patients benefiting from earlier access to clinicians having called 999.
- The aim is to improve response times for patients, while identifying the most appropriate care for the patient’s needs at first contact, which may or may not be an ambulance response.
- The NHS has identified a group of patients who will always require an immediate ambulance response – such as those experiencing strokes and heart attacks – and a group of patients (around 40% of Cat 2 calls) who may benefit from a call from a clinician to check their immediate care needs. These patients will either stay in their existing position on the stack, be reprioritised, or directed to alternative more appropriate services such as their GP or an urgent treatment centre.
- This process helps clinicians assess the severity of patients’ conditions. For example, for conditions like burns, diabetes, or headaches the severity of condition can vary hugely and will sometimes be best treated elsewhere. For example, a burn can vary from a small burn on the arm best treated at a pharmacy or urgent treatment centre, vs a very serious burn in need of an ambulance. The clinical assessment could possibly even escalate the patient to Cat 1.
- Evidence from the pilot so far shows:
- No patient safety concerns have been raised
- Improved ambulance response times for patients who need them most – reduces the overall size of the stack. Early pilot results showed a mean improvement during the incredibly busy month of December.
- The clinical assessment has actually upgraded some patients from Cat 2 to Cat 1, if they are identified as needing immediate life-saving care.
- Nearly half of calls that were clinically validated were closed with advice or referred to a better, more appropriate alternative service. Means a better experience and more appropriate care for those patients.
- Clinical validation is already used by ambulance services for Cat 3 and 4 patients.
- This approach has been developed with healthcare professionals and clinicians, and will be constantly reviewed to ensure patient safety.
- No patients are disadvantaged by this process. They keep their original position in the call stack if they are not reprioritised or referred to alternative services.
- Ambulance services have been experiencing significant demand, resulting in longer response times than our target for Cat 2 patients. This change will mean faster response times and more appropriate care for many patients calling an ambulance.
Patients requiring care and treatment for a less serious condition will still receive an ambulance response if needed, and this will be provided as soon as possible.
Had a patient with known IHD call Triage with 10 hr h/o unremitting central CP, radiating down the left arm with worsening SOB. I advised to call 999 right away. Wife called back 10 mins later, saying the operator told them there was a 4 hr wait and to go to the GP surgery to be connected to a “defibrillator” while waiting!
Told wife to not to wait for the ambulance but to take him straight to A&E, as needs prompt assessment and treatment to limit myocardial damage. Utterly dangerous and ridiculous advice by the 999 operator.
This has been happening for very many years as GPs have regularly reported. Is this just NHSE making it official?
One can never replace doctors. Paramedics are great in emergency but it is unfair to ask them making decisions about rest of medicine.
If ambulance staff can fix appointment with gp same day then it may help.
not contractual and unfunded
So who will be giving advice at first contact if classed as category 2? Will I be expected to stop what I am in the middle of to offer this advice? If so, afraid not. This is covered in our contracts and we are NOT an emergency service with urgent appointments those that are available within 24 hours. As currently happens, the triage 111/ambulance outcome of contact GP within 2 hours/6 hours/24 hours is patient advice and not GP contractual. Paramedics have their own chain of clinical support and GP advice when sought, which is an increasing phenomenon, is a professional courtesy only.
Fine, but my next appointment is in 4weeks time!
Dear All,
Problem is the reason they are calling NHS111 or 999 is because they’ve already called us, and we’ve said “thats not urgent – booked appt”.
If the people who run 111 and 999 only knew to what extent patients lie to get to their chosen end point.
Regards
Paul C
I am afraid I disagree. I did a 1 month analysis of received NHS111 reports, 80% gave advice to go to A/E urgently or call an ambulance. Whe we triaged them it was 20%. Good luck with that 60%
All the 111 does is read through a script.
They always are over cautious and want to send ambulances to almost everyone.
Don’t blame them, they are on national minimum wage and are not clinical.
What would help is improve same day access to GPs.
But the government prefers the cheaper 111-see-it-all model.