Launch of emergency unit appointment service is ‘way forward’ for NHS, GP says

The UK’s first dedicated service for booking A&E appointments has been hailed as “the way forward” for future NHS care by the GP in charge of it.

Cardiff and Vale University Health Board will launch its CAV 24/7 service on August 5, allowing patients with non life threatening illness or injury to be assessed over the phone before turning up at emergency or minor injury units.

It is hoped the scheme will help with social distancing and overcrowding at the A&E department at the University Hospital of Wales (UHW) in Cardiff.

But the service, which is free to call, will not replace access for life threatening emergencies which should still be directed to 999.

Dr Sherard Le Maitre, a GP and the project’s clinical director, said the launch was prompted by concerns patients were too scared to seek medical attention during the coronavirus crisis following a sharp drop in admissions.

He told the PA news agency: “There were lots of concerns initially that these were people that were significantly unwell and too afraid to come back to the emergency unit.

“But the analysis of the data actually showed that these were patients who had low acuity and minor injuries.

“So these individuals could actually either be managed elsewhere in the health system or by a bookable or managed appointment into the emergency unit.”

Patients who call CAV 24/7 will speak to a call handler trained to take information and recognise any urgent or emergency symptoms that may involve redirecting them to 999.

Someone with a non life-threatening condition will receive a call back from a nurse, paramedic or GP within 20 minutes, with hopes the service will eventually be expanded to include physiotherapists.

If an appointment is not needed they will be given advice, but those needing an appointment at an emergency or minor injuries unit will be given a time slot based on capacity at the site using a digital appointment system.

Patients who physically attend either UHW or the minor injuries department in Barry without first booking an appointment or being brought by ambulance will be assessed by a clinician at their entrances and directed to the appropriate place.

Dr Le Maitre said he believed the success of the system would lead to it being rolled out across Wales and beyond, with lessons learned to be shared with colleagues throughout the NHS.

He said: “This is not a flash in the pan for the pandemic.

“We think this is definitely the way forward.

“We are fortunate to be the first ones in Wales to do this, and hopefully we will be a pathfinder for wider roll outs across Wales.

“We’re going to be putting together lessons learned, and how we think what went well, what didn’t, and the challenges we face so we can share it with our other colleagues other health boards.”

Dr Le Maitre said the CAV 24/7 service was different to the “111-first” trial schemes being run in Portsmouth and London, as it is the first dedicated line to help “walking wounded” who can be managed in an emergency department.

Dr Le Maitre said it was difficult to say how much it would help ease demand at A&E sites due to difficulties categorising types of attendances in the past, but that part of the new system would help with doing so in future.

Statistics show that last year’s busiest day at the emergency unit at University Hospital Wales in Cardiff saw 515 patients attending on November 18.

Of those, 311 patients would have been suitable to call the CAV 24/7 number rather than presenting straight to the unit, with potential for 88 adults and 21 paediatric patients to have avoided an attendance at the unit and been given self care advice or been treated elsewhere.

The CAV 24/7 triage centre will be based at Cardiff Royal Infirmary, where an additional 20 triage nurses have been employed to help patients over the phone.

One triage nurse, Catherine Castle, said the service could help ease the burden on A&E departments dealing with people who could have been treated by their GPs or taking up capacity with accompanying family members.

She said: “Historically, people would sit there with their children or their grandparents.

“Now they will be asked ‘can you attend by yourself?’

“There won’t be that volume of traffic there which also causes issues and more work for busy A&E staff as well.”

Danielle Davies, operational manager for CAV 24/7, said it had been challenging to plan for the “unknown” of launching a “UK-first” system.

She said: “It’s a new concept, but it’s exciting.

“I think everyone’s pleased to be involved in this.”