Patients in Wales urged to make appointment before visiting A&E

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The ‘phone-first’ triage system will be trialled by the Cardiff and Vale University Health Board.

Stock image of a doctor with a stethoscope (Lynne Cameron/PA)

People with non-life threatening conditions are to be asked to make an appointment ahead of attending accident and emergency units in Wales, the Health Minister has said.

Vaughan Gething said people will be asked to phone first before attending as emergency services are remodelled to respond to coronavirus.

The “phone-first” triage system, which will be trialled at Cardiff and Vale University Health Board from next month, will direct people to a service for their condition or injury.

Those suffering life-threatening emergencies such as symptoms of a stroke, loss of breathing or a suspected heart attack should still call 999.

“The NHS has had to adapt quickly to respond to the pandemic, while keeping staff and patients safe and continuing to deliver the urgent and emergency care services people need,” Mr Gething said.

“We have looked very closely at how people access urgent and emergency care services, in response to the risks and restrictions the pandemic has brought.

Ambulances outside an A&E
Emergency situations will still be treated at A&Es (PA)

“Lockdown saw a sharp reduction in attendances at emergency departments, and a large increase in people accessing support and advice remotely via NHS 111 and online services.


“As attendances begin to return to more normal levels, these changes in how people have been accessing services over recent weeks is something leading clinicians say must be maintained.”

The Welsh Government said evidence suggests a proportion of people who come to an emergency department do not require the expert care provided by healthcare professionals there.

Instead, they would benefit from either self-care, or accessing advice, health or social care in other parts of the system, it said.

In the past month, as emergency departments have returned to a normal range of activity, some health boards have reported people queuing outside units as a result of reduced space inside due to social distancing.


Cardiff and Vale University Health Board’s “CAV 24/7 phone service” will direct people to “the right advice or treatment in the right place”, the Welsh Government said.

This could mean they are encouraged to self-care, be alerted to a service in their local community, or be directly booked in for a personal appointment in an urgent care centre or emergency department.

“People with life-threatening or serious conditions should continue to access services in the usual way but, with new physical distance measures in place, we need to better manage people with less severe conditions in their local communities or schedule urgent appointments
to avoid over-crowding and queuing outside departments,” Mr Gething added.

“We do not want to see large families or large groups of people congregating in departments, so we can protect people who are at risk, vulnerable or have been shielding, but we also recognise the need to ensure people get the right service for their needs.

“This can often be delivered in the community.”

A similar system is in operation in Denmark, where all but the most ill patients must ring ahead and make an appointment at an A&E unit.

Both the Royal College of Emergency Medicine (RCEM) and the Royal College of Physicians have expressed concerns about safety if emergency departments become overcrowded.

Dr Jo Mower, national clinical director for unscheduled care and vice president of RCEM, said: “We recognise the efforts made by the public to use emergency care services sensibly during the pandemic and thank them for this.

“However, we must learn to live alongside coronavirus and we never want to see overcrowding and long waits for a bed return to our emergency departments.

“We are working with Welsh Government to ensure patients are seen in the right place, which may be in the community, and by the right clinician, first time.”

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