Patients will be told to call 111 before attending Accident & Emergency departments under controversial reforms of the NHS.
Pilot schemes will be launched in every part of the country, urging patients who do not require an ambulance to book appointments at casualty units in advance.
NHS chiefs say the schemes aim to reduce crowding in A&E and direct people to the “most appropriate” place for help.
Those considering going to A&E will be asked to phone 111, or navigate its website, with those considered to need hospital care given a time slot to attend, and others directed to the best place for treatment.
But medics have raised concerns that the reforms could create deadly obstacles for those in need of urgent care.
It comes amid concern about rising numbers of deaths among those who went untreated for killer diseases such as heart conditions during lockdown.
Latest figures show the number of fatalities caused by high blood pressure rose by one third among those under 65s,in the two months ending 10 July. The same trend was seen in deaths caused by cardiac arrhythmias, while deaths from diabetes rose by one quarter in this group. The number of deaths and hospital admissions for coronavirus, meanwhile, have fallen to record lows since the peak of the pandemic in April.
Trials of “111 First” are now underway in Portsmouth, Cornwall, and about to launch in Newcastle and Blackpool and parts of London.
NHS chiefs plan to expand pilot schemes in every region of country, before full rollout of the schemes to all A&Es by December.
Dr Chris Moulton, former vice president of the Royal College of Emergency Medicine, said he feared that the changes could make it far harder for some patients to access urgent care.
“The last thing when you are in an emergency is to make a phone call; if you’ve chopped your finger off you dont want to phone before you go,” said Dr Moulton, an A&E consultant at Bolton NHS Foundation trust.
“We need to get back to face-to-face medicine and open access for patients immediately,” he said.
Health chiefs say that those who require an ambulance would not be diverted. And they have insisted that patients who turn up to A&E without an appointment will not be refused care.
However, Health Service Journal reports that on at least three occasions, patients with minor injuries who attended Portsmouth Hospitals trust, which is running the first pilot scheme to be launched, were told to call 111, after being were assessed. Portsmouth University Hospitals trust said no patient would be turned away from A&E.
The moves come as latest ONS figures show rising numbers of deaths for a number of conditions, especially heart problems, in recent months.
Charities said patients had paid “a heavy toll” for restrictions in access to the NHS, during lockdown, and said steps taken to limit face-to-face care during covid must not become “the new normal”.
The statistics, which cover the period from 8 May to 10 July, show that among under 65s, there were 1,129 deaths linked to high blood pressure, when around 843 would have been expected. There were also 323 deaths caused by arrhythmias, compared with a five year average of 242. The data also shows 10,923 deaths among the over 65s linked to high blood pressure, when around 9,477 would have been anticipated.
Rachel Power, chief executive of the Patients Association, said any changes in access to A&E required careful handling.
She said: “We’re supportive of initiatives to help direct patients to the right care as quickly as possible. If that means they can call 111 and get an appointment with the relevant expert clinician and seen on the same day, without hours waiting in A&E, that will be an improvement for patients.
“We would not support creating new barriers to patients getting care, such as by confusing and alarming patients who should be going to A&E but end up not doing so.”
Last month, a study of 50,000 patients found that deaths from the most common type of heart attack rose by nearly 40 per cent during lockdown.
The research prompted warnings that the Government’s “Stay Home” message may have had a “devastating” impact by deterring thousands of patients in medical crisis from seeking help.
The study, led by the University of Leeds, tracked more than 50,000 patients who had a heart attack and were treated at 99 major hospitals in England before or during lockdown.
It follows warnings that the number of people attending Accident and Emergency departments fell by 50 per cent at some points during the pandemic.
Previously, the head of the NHS had said most of the cases which stopped attending A&E involved minor conditions which could have been treated elsewhere.
In June, Sir Simon said a review of the type of cases which did not show up at A&E departments in April found that “by a ratio of about 14 to one, they were for the most part, more minor conditions that could be treated, either on a booked basis or at an urgent treatment centre, or in general practice.”
NHS medical director Prof Stephen Powis said the “111 first” model would help to ensure that A&E departments do not become crowded, which was increasingly important since the advent of Covid.
He told MPs that the move also aimed to make sure people got the most suitable care.
“We want to move, as we wanted to move before Covid, increasingly to a 111 first model that ensures we do everything we can to give appropriate advice to signpost people to the most appropriate place for treatment”.
NHS England’s latest board papers state: “The social ‘lockdown’ to control the spread of COVID-19 saw a sharp reduction in attendance at Emergency Departments (EDs), and a large increase calls to the NHS 111 service and use of NHS 111 Online.
Subsequently call volumes have returned to near normal and levels of attendance to ED are increasing.
“The NHS ‘111 First’ programme is working to introduce a number of initiatives to reduce the number of face-to-face contacts patients will need to experience in accessing urgent care services.”
The President of the Royal College of Emergency Medicine has said A&E appointments will help to prevent overcrowing when the NHS is attempting to maintain social distancing.
Dr Katherine Henderson said it would cause “enormous harm” to patients if Britain returned to crowded casualty units.
An NHS spokesperson said: “GPs, nurses, paramedics and other staff working in the NHS 111 phone and online service have already played a key role in helping millions of people get the right care and advice safely over the last six months – whether for coronavirus or any other urgent medical needs – and can already book people who need it into face to face appointments with local clinicians or arrange home visits.
“As the NHS now prepares for winter, we are further improving that offer with more clinicians and better links into local emergency departments, and will be launching a major public information campaign to ensure that people know how they can get the care they need in the safest way possible.”