As winter approaches and NHS areas prepare for seasonal pressures, the importance of efficient patient flow and demand management across urgent and emergency care (UEC) has never been greater. Our recent panel discussion, ‘Ready, set, flow this winter’, brought together clinical leaders from across England, Scotland, and Wales to share how rapid remote clinician-to-clinician telephone triage is transforming the way patients access care – improving outcomes, reducing admissions, and easing pressure on busy emergency departments (EDs).
Re-designing access and flow in England
Joe Matthews, Senior Urgent and Emergency Care Lead at NHS Buckinghamshire, Oxfordshire and Berkshire West (BOB) ICB, outlined how his area faces a high burden of chronic disease and multiple long-term conditions. To manage this, the ICB has reimagined patient access, creating new pathways that enable smoother flow between multiple providers. One standout example is the Frailty SDEC service at Buckinghamshire Healthcare NHS Trust (BHT). This MDT model, with advanced practitioners working closely with social care, enables joint decision-making and shared care, thereby reducing demand on ED.
To enable this transformation, BOB ICB utilises Consultant Connect to facilitate ‘Call Before You Convey’ conversations between ambulance clinicians, primary care, and hospital specialists. With a first-time connection rate of more than 90%, a vast majority of calls result in patients being safely managed in the community, supported by hospital-at-home teams or directed to Frailty SDEC – all of which avoid unnecessary admissions.
Joe described the service as revolutionary, noting that breaking down Consultant Connect data has allowed the team to better anticipate surges in demand and plan resources accordingly. Despite rising pressures, BHT has achieved a reduction in A&E admissions and climbed 30 places in national rankings, becoming one of the South East’s best-performing EDs.
Joe also highlighted the benefit of cross-border integration through Consultant Connect, enabling GP surgeries in neighbouring ICB areas to access shared admission avoidance pathways – ensuring no patient falls through the gaps.
Flow navigation and remote consultations in Scotland
In Scotland, Dr Gordon McNeish, Associate Medical Director and Emergency Medicine Consultant at NHS Lanarkshire, described how Flow Navigation Centres (FNCs) were launched in 2020 as hubs to reduce demand at hospital front doors. Working closely with the Scottish Ambulance Service, they implemented a ‘Call Before You Convey’ model to replace the old system where paramedics had to contact individual EDs – a process that became increasingly inefficient as demand grew.
Now, ED consultants across Lanarkshire’s three hospitals staff the FNC from 8am to 8pm, dedicating time to take calls, conduct video consultations, and offer safe alternatives to hospital conveyance, where appropriate. This multidisciplinary model has successfully reduced ED attendances whilst supporting early discharges to virtual wards, where patients received remote monitoring and clinical input from the FNC.
In addition, patients contacting NHS 24/111 with minor injuries or illnesses are offered same-day video consultations with clinical specialists, rather than automatically travelling to ED. As a result, around 45-50% of these patients avoid a hospital visit altogether, while those who do attend are given scheduled appointments, improving both efficiency and patient experience.
Managing lower acuity demand in Wales
From Wales, Peter Green, Clinical Development Lead at Welsh Ambulance Services University NHS Trust (WAST), discussed the critical role of rapid telephone triage in managing lower-acuity patients. Thousands of WAST clinician calls are routed through Consultant Connect each month, helping determine whether patients can be referred directly into community pathways or medical assessment units (MAUs) without dispatching an emergency resource.
Peter emphasised that this approach not only ensures high-acuity patients receive timely attention, but also enhances job satisfaction among ambulance crews – giving them the tools and confidence to safely manage patients in the right place, first time.
Because available services can differ significantly across neighbouring health boards, Consultant Connect provides a clear, real-time view of local options, ensuring clinicians can make informed decisions regardless of their geographic location. WAST also analyses call data to identify what works and where systems can be optimised, aligning patient needs with the right skills, whether in person or virtually.
Across all three nations, a common thread runs through these success stories: remote telephone triage is redefining what ‘front door’ care looks like. By empowering clinicians with immediate access to support, NHS areas can safely reduce unnecessary conveyances, improve patient experience, and strengthen multidisciplinary collaboration.
As Joe, Gordon, and Peter each demonstrated, data-driven communication platforms are not just easing winter pressure; they are helping to reshape urgent and emergency care for the long term. From avoiding admissions to enabling same-day alternatives, remote telephone triage is assisting the NHS to deliver the right care in the right place, the first time.
If you would like to discuss setting up a Consultant Connect project for your NHS area, please call us on 01865 951207 or email hello@consultantconnect.org.uk.
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