As our health board gears up for the annual winter rush, there are worries a perfect storm of seasonal and Covid pressures could overwhelm major hospital emergency departments (EDs).

Every year it seems Betsi Cadwaldr University Health Board suffers its busiest ever winter period.

It seems an ever-increasing number of frustrated people, who see emergency departments as a starting point to treatment rather than an emergency fall-back, are bumping up attendance.

Throw Covid into the equation and the recipe for this year becoming unmanageable for staff, with increased social distancing and a need to clean down thoroughly between patients, is easy to visualise.

So the Local Democracy Reporting Service (LDRS) has teamed up with Betsi Cadwaladr to assess how best to avoid interminable waits in ED and leave the service free for the most serious cases – but where to start?

Well the answer to that may be closer to your local high street than your local hospital.

Llyr Hughes – Community pharmacist

Llyr runs four pharmacies on the Llyn Peninsula and he believes people who can will need to take responsibility for themselves during the winter months.

He says people should make sure they are prepared for minor ailments by having paracetamol and any prescription drugs they need on hand and ordered in plenty of time, so they’re not left short.

He’s also urging people who qualify, which now includes anyone over 50 years old, to get their flu vaccine arranged as soon as possible.

High risk groups will naturally take priority but those who get the jab will help keep hospital admissions down.

He said: “By getting a flu vaccine, you’re doing your bit to protect others and support local health services – for every vaccine, that’s one more person who’s at a reduced risk, meaning there’s more precious resource for other people who really need it.

“If people feel they aren’t able to treat themselves, or need advice on something they don’t have a remedy for at home, then I would encourage people to get in touch with a pharmacy first.

“For minor illnesses, we really should be the first port of call.”

He said pharmacies can help people who have Covid symptoms without them having to visit the pharmacy in person, and all community pharmacies will get access to Welsh Government and health board technology, so they can conduct video conferencing and telephone consultations.

“By using technology, we can get any patient, even with COVID, to call the pharmacy and get advice”, said Llyr.

“Really, the first port of call for any acute or minor issue should be a community pharmacy.

“Community pharmacists are highly qualified individuals with a degree level training in acute conditions, and at the moment, we have a capacity and accessibility to see patients promptly

“If you need to be passed on, we can access systems to refer on to a GP,

or minor injuries unit, an optician, or an emergency department if needed, with a letter.

“I think traditionally, people just go to an Emergency Department with minor illnesses or acute conditions because for whatever reason they don’t know where else to go.

“I even hear about GP Out Of Hours seeing people for minor things like a sore throat, which absolutely should be sorted by a local pharmacy.”

He says EDs are for people who are severely unwell, have significant bleeding or their life is threatened.

Llyr added: “If any patient has run out of medication, they shouldn’t be  accessing GP out-of-hours or ED.

“We see people turning up in Emergency Departments for asthma inhalers, when they’ve passed three or four pharmacies which could have dealt with it.

“People need to get away from the idea that it’s OK to use emergency resources like this.”

Of course if you’ve had an impact injury, perhaps broken a bone, sprained something badly, or cut your self badly but it’s not life threatening, you should go to one of the region’s nine minor injuries units.

Jess Booker – emergency nurse practitioner at Holywell minor injuries unit

Jess Booker is an emergency nurse practitioner at Holywell minor injuries unit (MIU) in Flintshire.

Summer and winter presentations differ but she stresses it’s a unit for minor injuries.

She said: “There’s a long list of what we can help people with – the obvious ones being sprains, strains, insect bites, though obviously not as much at this time of year.

“Over the winter we see a lot of falls, impact injuries and wrist fractures. Really, minor injuries unit does what it says on the tin. It’s minor injuries, not minor


Jess said NHS Direct will give people advice but the MIU is happy for people to call ahead, so they can make sure people get the right treatment at the right time.

She said: “We want people to phone us first, so we can talk and see whether we can help or not. If it’s not something we can support with, we can still direct you elsewhere.

“If they’re just not sure, they aren’t wasting our time or bothering us. We’re happy to either sort out their problem ourselves or point people in the right direction.”

There is also an NHS waiting times app which will tell you of availability in MIUs across North Wales.

There are nine at: Holyhead, Dolgellau, Pwllheli,Tremadog, Tywyn, Llandudno, Denbigh, Holywell, Mold.

If you’re feeling acutely unwell you can always make an appointment with your local doctor. They are still open despite the pandemic.

Clare Corbett – Clarence House medical centre, Rhyl

GP Clare said the main problem during the pandemic has been people not presenting to their GP when they’ve been unwell or had serious symptoms.

She said it’s important people know they are there but services might be a little different to how they used to be.

She said: “We’ve seen cases where people are coming to us late, and quite poorly.

“People need to understand that we are here, we are accessible, and we don’t want people putting things off.”

Clare said using new technology, such as telephone and video consultations, was actually giving many people a faster diagnosis.

“Although people aren’t walking in off the street and waiting inside, we’re still seeing people when needed,” she said.

“Actually, we’ve found most people are getting a much quicker response or solution to what they need.

“Yes we’re working in different ways to normal, and yes you might not get a face-to-face appointment it’s not clinically necessary, but we’re using

technology to give people lots more options on accessing care.”

She added: “If someone really needs a face-to-face appointment, we will assess them remotely first to make sure there’s a clinical reason why they would need to come in, and that when they do it’s for the shortest length of time possible, to reduce the risk for everybody.”

She said the practice is “bracing” itself for the winter pressures and they are well underway with flu vaccinations.

They are also asking patients to see what over the counter solutions there are for them if they feel unwell, without putting off those who genuinely need to see a doctor.

She said: “People need to understand that we are here, we are accessible, and we don’t want people putting things off.

“We’re still seeing patients and remain open to help, just in a controlled way.”

Emergency departments are reserved for the most serious and emergency admissions, or they should be.

Tom O’Driscoll – Ysbyty Glan Clwyd emergency department

Tom is an emergency consultant and clinical lead on Ysbyty Glan Clwyd’s ED.

He wants people to “think long and hard” before choosing to visit any of North Wales main emergency departments.

He said: “Some things are clearly obvious reasons to come here. But if you’ve got symptoms which you’ve had for a while, then really we would suggest having a chat with their GP or a pharmacist about it first.

“Clearly, there’s still a number of things which remain obvious signs that something is seriously wrong.

“Things like severe breathlessness, chest pains, severe headaches and vomiting, severe abdominal pain, profuse bleeding, ailments known to be linked to existing or historical issues like cancers.

“For other conditions which are known to potentially lead to sepsis or infection, they need to think about calling for help or getting to us to be checked out.

“Signs of things like a stroke, cardiac arrest, or a bleed on the brain, these are all time critical conditions, and we don’t want people to hesitate if they have a feeling something is wrong.

“Currently, we’re seeing a slight drop in numbers of attendees to our emergency department, a very slight drop on last year.

“But it has become difficult to move people through the system because of a lot of activity in the hospital.

“Part of that is about losing beds to Covid as a way of keeping people safe, and keeping as much of our other services going, the emergency work and cancer work.

“The bigger picture is that we’ve got the NHS trying to carry on and pick up for lost time over the spring and summer, and more Covid on top.

“The combination of the two is a real challenge for us, in keeping people separate in the ED and moving through quickly and safely.

“If people have concerns from a Covid point of view, about whether they need

treatment, I’d ask them to think about how unwell they are with it.

“Similar to previous winters with colds and flu, if they have those symptoms, they need to think about managing themselves in a similar way, and they need to think about getting tested through the right channels, not by turning up at ED and asking for a test or advice.

“I’d ask people to call NHS Direct and use the NHS websites, and use the testing system which is in place, rather than turning up to ED.”

For initial advice, go to NHS 111 Wales at:

Or in North Wales you can call the service on 0345 4647 (calls at local rate) on land line and mobile.

You can see get details about local pharmacists and their phones numbers at:

Find your local minor injuries unit here:

Find a full list of GP surgeries here:

For more details on the waiting times app for MIUs and EDs go to:

Find the three main emergency department contact details here: