200,028 winter A&E visits were for minor conditions. Here’s how Pharmacy First, urgent treatment centres and NHS 111 reduce pressure and protect capacity.
A&E Overload: Fixing Winter Pressure Without More Beds
A single sore throat shouldn’t cost an A&E clinician’s attention in December. Yet last winter in England, 96,998 people went to A&E for a sore throat, and 83,705 attended for earache. Add blocked noses (6,382), itchy skin (8,669), ingrowing nails (3,890), and even hiccups (384), and the total reaches 200,028 A&E attendances for conditions that could usually be handled elsewhere.
This isn’t a story about “silly patients”. It’s a story about a system that has trained people to think A&E is the most reliable front door when they feel unwell—especially in winter, when GP appointments feel scarce and symptoms worsen fast.
Here’s the good news, and it’s central to the Healthcare & NHS Reform conversation: the NHS is actively modernising access so people can get the right care sooner—through Pharmacy First, urgent treatment centres, NHS 111, online consultations, and the NHS App. If we want to reduce waiting lists and protect hospital capacity, this is where the real wins are.
The fastest way to relieve A&E is to change the front door
Answer first: The quickest, most scalable way to reduce A&E pressure is to redirect “minor-but-urgent” demand to services built for it—pharmacies, urgent treatment centres, and 111-led booking—so hospitals can focus on genuine emergencies.
A&E isn’t overloaded only because more people are ill. It’s overloaded because it’s become the default option when people can’t predict what will happen elsewhere. If you’re worried at 7pm on a Saturday, you don’t want a maze—you want certainty.
That’s why the current NHS push matters. It’s not just a winter comms campaign; it’s a reform approach: expand routes into care, make them reliable, and make them easy to understand.
Two data points from the NHS release underline the opportunity:
- A&E attendances were 37,000 higher in October than the same month last year. Winter pressure is arriving earlier.
- Blocked nose attendances jumped by nearly a third last winter compared to summer 2024 (4,943 vs 6,382). People are turning up at A&E when seasonal symptoms spike.
If you’re thinking about NHS capacity in practical terms, this is the logic: every avoidable A&E attendance is time, space, and staffing that can be reallocated to critical care and flow, which helps the whole hospital run better.
Why “minor” visits aren’t minor to the system
A sore throat is minor clinically (most of the time). Operationally, it’s not. Each attendance triggers:
- Reception and streaming
- Triage observations
- Clinical assessment
- Potential tests
- Discharge admin and safety-netting
Even when a patient is seen quickly, the cumulative effect is brutal. It slows down assessment space, adds queueing, and increases risk for patients who truly need emergency care.
Pharmacy First: the most under-used capacity in the NHS
Answer first: Pharmacy First is a practical capacity plan because it moves common winter conditions to a trained workforce that can treat promptly—often with prescription-only medicines—without consuming A&E or GP appointments.
Pharmacies already exist on high streets, in supermarkets, and near transport hubs. They’re open longer than many GP services. And crucially, they are staffed by clinicians who can manage a wide range of minor illness safely.
Under Pharmacy First, patients can access quick support for seven common conditions including sore throat, sinusitis and earache—exactly the things showing up in the A&E numbers.
This winter expansion also includes two changes that signal modernisation rather than tinkering:
- Emergency contraception available from pharmacists during winter (a first).
- Support for people newly prescribed antidepressants, helping prevent drop-off, side effects going unmanaged, and avoidable deterioration.
That second point matters more than it might sound. When mental health medication is started, the first weeks are where questions and concerns spike—sleep, nausea, agitation, anxiety about “is this normal?”. If people can get fast advice locally, you reduce escalation to urgent services.
What to use Pharmacy First for (and what not to)
A simple rule I use when advising friends: if you’re well enough to walk into a shop and describe symptoms clearly, the pharmacy is often the best first stop.
Typically suitable:
- Sore throat, earache, sinus symptoms
- Rashes/itching that isn’t severe or rapidly spreading
- Minor skin infections or bites (depending on severity)
- Uncomplicated UTIs in eligible groups (where offered)
Not suitable—use 111 or urgent care instead:
- Breathing difficulty, chest pain, collapse, severe allergic reaction
- Severe abdominal pain, sudden weakness, stroke symptoms
- Significant head injury, uncontrolled bleeding
This isn’t about gatekeeping. It’s about matching the problem to the service that can treat it fastest.
Urgent treatment centres: A&E capability, without the A&E bottleneck
Answer first: Urgent treatment centres (UTCs) reduce A&E congestion by providing assessment, diagnosis, and treatment for common injuries and illnesses—often with shorter waits and better patient flow.
The NHS is opening new urgent treatment centres across England, including recent openings in Plymouth, Lymington (Hampshire), and Yeovil. These centres are designed for the “middle ground” that clogs A&E:
- Sprains and minor fractures
- Minor burns
- Wound care
- Infections that need same-day assessment
- Illnesses needing basic diagnostics
Many are open at least 12 hours a day, and importantly, patients can attend as walk-ins or be booked via NHS 111.
That booking model is a quiet reform with big implications. It turns urgent care into something closer to scheduled care—less queueing, less uncertainty, more predictable staffing.
The system benefit: protecting A&E for life-threatening emergencies
A&E works best when it’s reserved for what only A&E can do:
- Resuscitation
- Major trauma
- Severe sepsis
- Suspected stroke/heart attack pathways
When A&E becomes a catch-all, performance drops for everyone. If you care about NHS waiting lists and elective recovery, this connection is direct: crowded emergency departments slow inpatient flow, which delays discharges and cancels planned care.
So yes—an ingrowing toenail can affect your day. But hundreds of “small” attendances can affect the whole hospital.
Digital access: stop treating “online” as a side option
Answer first: Digital routes—online GP consultations, NHS App services, and 111 online—reduce friction and keep demand in the right place, especially during winter surges.
The NHS data highlights that 98.7% of GP practices now offer online consultation requests, and 8 million people benefited in October. That’s not a niche channel anymore; it’s mainstream access.
Digital access helps in three practical ways:
- It time-shifts demand. Patients can submit requests without the morning phone rush.
- It improves triage quality. Structured questions often capture key red flags.
- It routes faster. The right clinician (or service) can respond, rather than forcing everyone into the same queue.
Then there’s the NHS App, which has become a genuine “self-serve layer” for healthcare:
- Request appointments
- Check health records
- Receive reminders
- Order repeat prescriptions
For the NHS reform agenda, this is what modernisation looks like when it works: reduce admin load, reduce avoidable appointments, and give patients confidence that something is happening.
A practical winter playbook for patients and families
If you’re supporting children, elderly parents, or just trying not to lose half a day to the wrong waiting room, keep this simple ladder on your fridge:
- Self-care for mild symptoms (fluids, rest, pharmacy advice)
- Community pharmacy / Pharmacy First for common infections and minor illness
- NHS 111 (phone or online) for urgent advice and bookings into services
- Urgent treatment centre for injuries/illness needing same-day assessment
- A&E / 999 for life-threatening conditions and serious injuries
The NHS message is consistent: use A&E for genuine emergencies, and use 111 to reach the right service for everything else.
Winter 2025 reality: flu, strikes, and why behaviour matters more than headlines
Answer first: This winter is high-risk because flu is rising and industrial action disrupts capacity—so using the right care pathway isn’t just convenient, it’s protective for the whole system.
NHS England has warned that the period around the resident doctors’ strikes (17–22 December) is “the most dangerous time of year for hospitals” because baseline demand is already high. That risk stacks on top of seasonal respiratory illness.
The NHS has delivered 16,334,878 flu vaccines so far this autumn, which is over 450,000 more than at the same point last year (15,881,979). That’s a serious prevention effort—and prevention is the most cost-effective kind of capacity building.
But vaccination only covers part of the winter surge. The other part is what happens when symptoms start:
- Do people wait for advice early, or do they arrive at A&E after days of worry?
- Do they use pharmacy and 111, or default to the one door they know will be open?
Public behaviour is shaped by trust. The NHS reform challenge is to make these alternative routes not only available, but dependable.
A simple truth: you can’t reduce A&E waiting times only by improving A&E. You reduce them by preventing avoidable arrivals.
What this means for NHS reform (and why it’s a genuine success story)
The most credible version of NHS reform isn’t a single big announcement. It’s a set of operational changes that make access clearer, faster, and safer.
This winter push shows three reform principles that actually work:
- Modernising healthcare delivery by widening care pathways (pharmacy, UTCs, digital)
- Reducing A&E pressure to protect emergency care and improve hospital flow
- Sustaining capacity long-term by helping people choose the right service first time
If we’re serious about reducing waiting lists, this is part of the engine room. When emergency care is congested, elective recovery suffers. When emergency care flows, planned care is easier to deliver. The system is connected whether we like it or not.
If you’re leading within healthcare—or supplying it—this is also where practical opportunities sit: better triage tools, clearer service navigation, support for community capacity, and smarter patient communications that don’t shame people, but guide them.
What would happen next winter if “call 111 first” felt as natural as “go to A&E”?