The health secretary, Jeremy Hunt, has floated the idea of stopping walk-in patients from attending hospital emergency departments in an attempt to head off a winter crisis in the health service.

NHS England has denied it plans to pilot an idea that would require patients to consult their GP or NHS 111 before being allowed to go to A&E.

However, Dr Helen Thomas, its national medical adviser for integrated urgent care, said the health secretary was considering testing the idea.



“Jeremy Hunt has mentioned to some of my colleagues, maybe we should have a ‘talk before you walk’ and we may well pilot that,” Thomas told a conference, according to a recording released by the doctors’ magazine Pulse.

Labour, the BMA and the Patients Association said Hunt’s idea revealed the depth of the financial crisis facing the NHS.

Thomas admitted that even piloting the idea was a “hot potato” but said early discussions had been held.

“I think it’s been done in other countries where they’ve actually said you can’t come into ED (emergency departments) until you’ve talked on referral, or you have to have that sort of docket that you’re given by having talked on the phone that you do need to come to ED.”

Speaking to an audience at an Urgent Health UK event in Birmingham on Thursday Thomas said that only 20% of walk-in patients called 111 before attending A&E. Of the 80% who did not, she said: “Some of them will need ED, but there’s an awful lot that won’t.”

Thomas admitted that making patients consult their doctor first would put pressure on GP out-of-hours services.

NHS England played down Thomas’s comments. A source told the Guardian: “There are no formal plans to consider any pilots about stopping walk-in patients. It was just a pie in the sky possibility that Pulse have massively overblown.”

Prof Helen Stokes-Lampard, chairwoman of the Royal College of GPs, said she understood the proposed pilot scheme would only involve phone referrals to A&E via 111.



If, as reported, it would also involve patients having to visit their GP, this would be counterproductive, she said.



“Pressures in the NHS are not restricted to emergency departments – intense workload and workforce issues are being faced in general practice too, and this would simply create further capacity problems, and increase bureaucracy for a profession already drowning in it.

“We know that the main issue contributing to pressures in A&E is not inappropriate attendance, but a lack of hospital beds, and a lack of the community support services patients need when they are discharged, so they end up staying in hospital for longer than they needed to.”

A Department of Health spokesperson said: “There are absolutely no plans to pilot this approach – patients can be reassured that unprecedented planning has gone into preparing the NHS for this winter, supported by an extra £100m for A&E departments and £2bn for the social care system.”

The shadow health secretary, Jonathan Ashworth, said: “The NHS is being pushed to the brink with underfunding so bad that ministers are in secret discussions to ban sick or injured people from walking into A&Es. Patients deserve better.

“Preventing patients from walking into A&Es is not a plan to help the NHS but an abdication of responsibility. Labour would implement a proper plan to make sure accident and emergency services are available to those who need them.”

Rachel Power, the chief executive of the Patients Association, said the A&E idea was impractical: “Will the parent of a child who has fallen and broken their arm, for instance, really have to call 111 or get a GP referral first? Are they even likely to know such a bar exists? Will there be bouncers on the door, turning people away?”

She added: “Maybe a pilot will identify some good ways of reducing genuinely inappropriate use of A&E, but that this idea is even circulating speaks volumes about the consequences of the government’s decision to underfund the NHS. The chancellor must take note, and respond in his budget next month.”

Dr Chaand Nagpaul, the chair of the British Medical Association, said: “Trying to solve a problem in one part of the NHS by shifting it on to another won’t work. Pressure on emergency departments is down to seriously ill patients and a lack of capacity and funding across the whole system.”

He said the proposal would just increase both the pressure on staff and bureaucracy for patients. “It could also have the added effect of increasing the burden on the ambulance service as people could instead just call an ambulance to get a place in A&E.”

Nagpaul said better patient education about the purpose of A&E was needed, but the government needed to “urgently address the funding, capacity and recruitment issues”.

Meanwhile, Hunt said GPs needed longer than 10 minutes to meet some patients’ needs.



Speaking at the Royal College of GPs’ annual conference in Liverpool on Thursday, he said: “The old model of 10-minute appointments doesn’t really work for patients with multiple long-term conditions who may need 30, 40, 50 minutes to get to the bottom of all their needs.”