The growing pains of the 2024/2025 Portugal's NHS Telephone Triage System National Rollout

Francisco Goiana-da-Silva^1*Mário Amorim-Lopes²Fernando Correia³João Pereira³Afonso Ribeiro³Duarte Tude Graça^4*Tomás Pessoa-e-Costa⁵Luís Cabral⁶Eduardo Costa⁷Alexandre Morais Nunes⁸Hutan Ashrafian⁹Ara Darzi¹⁰

• ¹Institute of Global Health Innovation, Faculty of Medicine, Imperial College London, London, United Kingdom
• ²Universidade do Porto, Porto, Portugal
• ³Sword Health Inc, Draper, United States
• ⁴Universidade de Lisboa Faculdade de Medicina, Lisbon, Portugal
• ⁵Unidade Local de Saude de Amadora/Sintra, Amadora, Portugal
• ⁶Servico Regional de Protecao Civil e Bombeiros dos Acores, Angra do Heroísmo, Portugal
• ⁷CEGIST - Centre for Management Studies of Instituto Superior Técnico, University of Lisbon, Lisbon, Portugal
• ⁸Universidade de Lisboa Instituto Superior de Ciencias Sociais e Politicas, Lisbon, Portugal
• ⁹Imperial College London Institute of Global Health Innovation, London, United Kingdom
• ¹⁰Imperial College London Department of Surgery and Cancer, London, United Kingdom

In 2024, the Portuguese NHS introduced "Ligue Antes, Salve Vidas" ("Call Before You Go, Save Lives"), making phone triage on the national SNS 24 line compulsory prior to an emergency department visit in most NHS Local Health Units. While the policy was as much concerned with enhanced access to urgent care, it was quickly rolled out without corresponding investment in infrastructure. Using full-population administrative data (January 2024–May 2025), it was assessed whether the system can meet growing demand, applying a Holt–Winters model to project call volumes and these forecasts were compared with a fixed benchmark of installed capacity, allowing estimation of unmet demand and waiting times. This winter, 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 that is why policy options include AI-supported triage, targeted workforce reinforcement, and enhanced transparency to ensure system resilience.