Sick patients across the north-west of England will have to get themselves to A&E or take a taxi from GP surgeries, walk-in centres and care homes during this week’s ambulance strike. In a letter on Monday, the North West Ambulance Service (NWAS) has warned GPs and hospitals that the loss of so many of its crews as a result of the pay dispute walkout will significantly restrict the service it can offer to the public. That will mean that patients who are found to be unwell in a GP practice, walk-in centre, urgent treatment centre or care home and who need to seek help at A&E will have to rely on “immediate self-conveyance or taxi conveyance” rather than an ambulance. An ambulance will come to take a patient to A&E only if they are confirmed to be having a cardiac arrest or if there is another immediate risk of them dying, it added. NWAS’s letter is likely to heighten the already acute concern among NHS bosses that patients will be at much greater risk than usual of coming to harm, and even dying, because of the strike. The disclosure of NWAS’s letter comes amid wrangling on Monday between the health secretary, Steve Barclay, and NHS trade unions over what level of cover ambulance staff should provide when they strike in England and Wales from midnight on Tuesday night to a minute before midnight on Wednesday. The GMB intends to stage a second 24-hour stoppage on Wednesday 28 December. Members of Unison, Unite and the GMB unions working in NHS ambulance services will go on strike on Wednesday in protest at the government’s pay award of £1,400 for 2022-23 and ministers’ refusal to engage in negotiations about an improved deal. The NWAS provides emergency and non-emergency ambulance services to 7 million people in Merseyside, Greater Manchester, Lancashire, Cumbria, Cheshire and Glossop in Derbyshire, an area of 5,400 sq miles. In its letter, the NWAS has warned GPs, NHS trusts and providers of NHS 111 telephone advice services in its area that the two strikes “will see a large proportion of our workforce striking throughout the region”. It added that while “we are taking steps to minimise the impact on the public and ensure we can respond to life-threatening emergencies during the periods of action. However, we need you to be aware that there will be a significant and noticeable difference in the way we operate on 21 and 28 December.” Although each strike is for one day, the impact on the availability of ambulances will last for three days, it warned. “We expect operational challenges to last for a further 48 hours, so our advice is to plan for 72 hours of disruption.” Its letter also makes clear that it will not be able to help transport patients whom hospitals want to discharge, which NHS England has made clear is a major priority, to help free up beds ahead of the first strike, and that “volunteer drivers” and taxis will be needed. NWAS has advised trusts in its area that they should “consider stepping up alternative providers to support discharge and other patients who may need transport for appointments, eg volunteer drivers, taxis and private ambulance providers”. It is not clear if by “volunteer drivers” it is suggesting that friends, relatives, carers and neighbours should assist patients awaiting discharge or who need to get to a hospital appointment. Unions have agreed that ambulance crews will respond to category one calls, which involve life or death emergencies and are the most serious types of 999 calls. However, there is as yet no agreement on whether they will also attend category two calls, which include suspected heart attacks and strokes, for which patients need urgent medical treatment, often in hospital. NWAS’s letter made clear that on strike days it will also not be able to: Transfer patients between hospitals except for kidney, cancer and palliative care appointments between today and Friday 23 December and again on 28 December. Or ttransfer seriously unwell patients from intensive care units, high dependency units and coronary care units. Its crews will still attend obstetric emergencies involving pregnant women and take them to hospital. However, mothers-to-be with less serious problems could also have to rely on taxis or get themselves there. “Immediate self-conveyance or taxi conveyance will be advised in all other circumstances” [apart from obstetric emergencies],” the three-page letter adds.