A respected Belfast doctor has suggested shutting the doors of the Royal's emergency department to the public could be one solution to ease the pressure.
Senior GP Dr George O'Neill's proposed model to solve the problems facing Northern Ireland's emergency departments include no admittance without a GP's letter or via an ambulance.
Dr O'Neill has been in practice in north and west Belfast for 40 years.
He said: "One emergency department (ED) on the RVH site, closed to the public with access only via a blue light ambulance or a letter from a doctor."
Dr O'Neill also suggested the closure of the emergency department at the Mater Hospital.
He said: "There was a public outcry when the City casualty was closed. Belfast simply does not need two ED units a mile from each other.
"The Mater ED is being kept open for political reasons, not clinical. ED staff are specifically trained to deal with trauma: they are there for car crashes, heart attacks, strokes etc.
"They are not there to stitch up your finger."
The Royal Victoria Hospital has been plagued with overcrowding problems in the past year and in September more than 100 people were waiting in one evening for treatment - with five waiting for almost 20 hours.
Dr O'Neill also suggested a single out of hours unit operating 24/7 adjacent to but separate from the single emergency department.
He said: "The 24/7 out of hours ideally should be the responsibility of a GP-operated and controlled community interest company or mutual.
"It should be integrated with other out of hours services (social work, mental health crisis response, community nursing, chronic disease, pharmacy etc).
"This is where patients will walk into. If their condition is serious they will be transferred to the adjacent ED."
He also encouraged more use of pharmacists and paramedics.