# The growing pains of the 2024/2025 Portugal’s NHS telephone triage system national rollout

## TL;DR

Portugal's new NHS phone triage system is struggling with high call demand, risking patient safety and trust without infrastructure upgrades.

## Contribution

The paper quantifies the unmet demand in Portugal's NHS phone triage system and proposes policy solutions to prevent overload.

## Key findings

- Without infrastructure upgrades, Portugal's NHS phone triage system will miss up to 1 million calls in winter 2025–26.
- Current triage capacity is insufficient to meet projected call demand, risking clinical safety and equity.
- AI support, workforce reinforcement, and transparency are suggested to improve system resilience.

## Abstract

In 2024, the Portuguese NHS introduced “Ligue Antes, Salve Vidas” (“Call Before You Go, Save Lives”), making phone triage through the national SNS 24 line compulsory prior to an Emergency Department (ED) visit in most NHS Local Health Units. While the policy was rightfully concerned with improving timely access to urgent care, it was quickly rolled out without a corresponding investment in infrastructure. The phone triage system’s ability to meet growing call demand was assessed using full population administrative data (January 2024–May 2025), applying a Holt–Winters model to project call volumes. These demand forecasts were compared with a fixed benchmark of installed capacity, allowing for the estimation of unmet demand and waiting times. The authors’ projections show that, without structural reinforcement, the SNS 24 line will face persistent overload, with up to 1 million unanswered calls during the 2025–26 winter season. Unless structural adaptations are implemented, current gaps threaten clinical safety, equity, and public trust. Robust policy options like AI-supported triage, targeted workforce reinforcement, and enhanced transparency are critical to ensure system resilience.