The government has confirmed plans to shake-up accident and emergency care in England this winter with plans that could see patients having to dial NHS 111 before going to A&E.
Ministers are also planning a consultation on scrapping the totemic four-hour waiting time target and replacing it with new performance measures. Hospitals have not hit the A&E target since July 2015. Details will be published before December.
Initially, the new A&E booking system is being piloted in Cornwall, Portsmouth and Hampshire and Blackpool and Warrington but if successful could be rolled out across the country to all hospitals as soon as December.
The prospect of having to book a slot in A&E first emerged in July, when pilots were launched by NHS England at hospitals in Portsmouth and Cornwall.
The move is being made in response to the Covid-19 pandemic, with experts believing it makes sense to triage patients by phone or online rather than having people sat in waiting rooms.
The government also wants to reduce pressure on emergency departments as staff battle winter pressures, including from coronavirus and seasonal flu.
A campaign called Help Us Help You will launch later in the year to urge people to use the new service.
The Department of Health and Social Care said it would spend £24m on more NHS 111 call handlers, who would be brought in to take on the additional workload, alongside extra clinicians.
Under the new changes, patients will still be able to seek help at A&E without an appointment, but officials say they are likely to end up waiting longer than those who have gone through 111.
The idea is that NHS 111 workers direct patients to the most clinically appropriate service, including A&Es, urgent treatment centres, GP surgeries or mental health care.
People with a life-threatening condition should still call 999.
As part of the announcement, the government also pledged an extra £150 million of funding to expand and upgrade 25 more A&Es to reduce overcrowding and improve infection control ahead of winter.
This was on top of £300 million announced for 117 NHS trusts to upgrade their facilities as part of a £1.5 billion capital funding for the health service announced by prime minister Boris Johnson this summer.
Data from the Department for Health and Social Care suggests there are 14.4 million A&E attendances in England that have not gone through NHS 111, a GP or via an ambulance.
It said 2.1 million attendances do not lead to an admission or treatment.
Dr Cliff Mann, NHS national clinical director for urgent and emergency care, said: "While emergency admissions are now back to near normal levels and 999 calls are actually above usual, Covid infection control means rethinking how safely to look after people who might previously have been to an emergency department for a more minor condition.
"Local teams are working hard to expand and adapt services to ensure people can continue to get the care they need safely, whether that's in hospital or closer to home.
Dr Katherine Henderson, president of the Royal College of Emergency Medicine, said: "Expansion of NHS 111 will help patients to be seen more quickly by the service most appropriate to their needs.
"We are pleased to have reached the consultation phase of how A&E performance is measured with a focus on the safe, timely care of the very sickest patients, and look forward to the publication of the proposals."
Health secretary Matt Hancock, said: "We are investing £450 million to make sure our A&E departments are ready for winter.
"Hospitals around the country will be able to expand and upgrade to ensure they can continue safely treating patients in the coming months.
"During the peak of the pandemic we saw millions of people using NHS 111 to get the best possible advice on Covid-19, and other urgent NHS services.
"These pilots will build on this and test whether we can deliver quicker access to the right care, provide a better service for the public and ensure our dedicated NHS staff aren't overwhelmed.”
Additional reporting by agencies.