Patients who need to go to A&E in England will be urged to book an appointment first through NHS 111 as part of a shake-up of emergency services. If the pilot schemes are successful, the system could be rolled out to all NHS trusts in December, with patients told they should call ahead to book a space in the emergency department. The move is being made in response to the Covid-19 pandemic, with experts saying it makes sense to triage patients by phone or online rather than having them sitting around in waiting rooms. The government hopes to reduce the strain 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 (DHSC) said more NHS 111 call handlers were being brought in to take on the additional workload, alongside extra clinicians. A consultation on new targets for A&E waiting times is also being launched. Ministers are expected to scrap the current four-hour target. Under the changes, patients will still be able to seek help at A&E without an appointment. But they would probably end up waiting longer than those who have gone through 111, according to officials. 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 pledged an extra £150m to expand and upgrade 25 more A&Es before winter. It said this was on top of £300m announced for 117 trusts to upgrade their facilities. The health secretary, Matt Hancock, said: “We are investing £450m to make sure our A&E departments are ready for winter. … 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.” DHSC figures suggest there are 14.4m A&E attendances in England that have not gone through NHS 111, a GP or via an ambulance each year of which 2.1m do not result in admission or treatment. The 111 pilot schemes are live in Cornwall, Portsmouth, Hampshire and Blackpool, and have just begun in Warrington. Dr Cliff Mann, the 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. “This additional investment will help us continue the development of NHS 111 and provide a broader range of services, with direct booking that will ensure all patients can see the right clinicians in the right setting, and address the extra challenges posed by Covid-19 so that emergency departments can safely treat those patients who do require their services.” Dr Katherine Henderson, the 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.” Chris Hopson, the chief executive of NHS Providers, said trusts would welcome the funding, as it would “enable them to provide better care for their patients this winter”. He said: “The proposals to use 111 as a key ‘front door’ to emergency care and redirect patients to the right service, avoiding the need to attend busy emergency departments when not required, are the right approach.