NHS considers A&E walk-ins for referred patients only

NHS officials have held talks about banning patients from turning up at Accident & Emergency departments if they have not been referred by a doctor.

The radical idea, discussed by officials at NHS England, would mean patients could only be treated in casualty units if they had been referred by their GP or via 111 phone lines.

Patients’ groups were sceptical, asking if “bouncers” would be placed on the doors of A & Es to keep out the sick.

The BMA and the Patients Association said the discussions – revealed at a conference on Thursday – showed the depth of the crisis facing the NHS.

Dr Helen Thomas, national medical adviser for integrated urgent care at NHS England, said officials were considering piloting schemes requiring all A& E walk-in patients to have a referral, unless they arrived by ambulance.

In a recording, released by the doctors’ magazine Pulse, she said: “Jeremy Hunt has mentioned to some of my colleagues, maybe we should have a ‘talk before you walk’ and we may well pilot that.

“I think it’s been done in other countries where they’ve actually said you can’t come into ED (Emergency Department) until you’ve talked on referral or you have to have that sort of docket that you’re given by having talked on the phone.”

Dr Thomas added that while piloting such a scheme would be a political “hot potato”, a pilot of the scheme could yield “some really interesting information”. She said too many patients were needlessly coming to A & E. Just one in five patients attending A& E had tried 111 first, when an “awful lot” of patients did not need to attend casualty, she said.

Dr Thomas said that the discussions of a pilot are in the early stages and admitted: “It’s going to be tricky to do it.”

The British Medical Association (BMA) said forcing desperately ill patients to go through an extra layer of bureaucracy was too risky, causing them further delays.

Dr Chaand Nagpaul, BMA council chairman, said such plans could even fuel extra demand for ambulances, as people tried to find a way to access hospital care.

Rachel Power, chief executive of the Patients Association, questioned how such schemes could work: “Will the parent of a child who has fallen and broken their arm, for instance, really have to call 111 or get a GP referral first? Will there be bouncers on the door, turning people away?”

A Department of Health spokesman said: “There are absolutely no plans to pilot this approach – patients can be reassured that unprecedented planning has gone in to preparing the NHS for this winter, supported by an extra £100million for A& E departments and £2billion for the social care system.”

She said ministers and officials discussed many ideas without them ever being drawn up as policy proposals.