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Independents' Day

GP emergency hospital admissions drop as admissions by A&E soar

GP emergency admissions to hospitals have fallen by 17% in the past decade, contrasting with an increase of 72% in the number of emergency admissions from A&E departments into hospital.

A study, published today in the Journal of the Royal Society of Medicine, found that emergency hospital admissions by GPs fell from 1.12m in 2001/02 to 0.93m in 2010/11, with admissions from A&E rising from 2.1 million to 3.6 million in the same period.

The study authors suggest that demographic changes are partly responsible and claim that ‘increased failure of management’ in primary care - where access problems or unmet expectations see patients presenting at A&E - accounts for the rest of the change.

But GP urgent care leads have previously explained the pressures were to do with a lack of A&E consultants, leaving increasing numbers of ‘risk averse’ junior doctors to admit more patients.

Lead author, Thomas Cowling from the School of Public Health at Imperial College London, said: ‘Whatever the explanation, the role of A&E departments as portals for emergency admission has grown, despite efforts to reduce A&E attendance rates.

‘A&E staff now have increased responsibility as gatekeepers for inpatient care and as care coordinators, which is not reflected in how A&E departments’ activity is measured or reimbursed.’


Readers' comments (10)

  • It's the 4 hour wait and nothing else.

    In 2002 you could sit there for 12 hours - a disincentive. Now you are pretty much always done in 4 hours.
    Whats not to like?

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  • This goes againt the the present issue with GP`s admitting too much.
    Well If they were admitted inappropriately its the mistake of the A&E. If they were admitted appropriately then GP`s cant solve the problem as how do you NOT admit anymore who needs admission.
    If the politicians want GP`s to take more risks than thay are at the moment then they will have to reimburse Medical Defenbce fees like Hospital Consultants.
    The Average indeminity cost for Obstetric consultant in hospital runs into hundreds of thousands of pounds per year apparantly.
    NHSE has to choose they cant have it both ways!

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  • A bunch of hospital Drs write a report to look into why their a&e department is getting more busy..and guess's managment of the bunch of Drs outside of the hospial thats to blame ...supprise supprise.
    Anyone consult a GP whilst writing this report? Almost certainly not ....this is from the Royal Society of Medicine....Hospital Hospital Hospital ... over represented in funding and over represented in 'reports'...not a way to solve problems ...and an example of exactly why problems like this aren't being solved

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  • They need to look at how the information is collected. We send patients in, appropriately arranged, and then get an A+E discharge summary as there were no clinical decision unit beds!

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  • Azeem Majeed

    This full text of this study can be viewed at:

    The study concludes that staff working in A & E now have a greater role in gatekeeping.

    The study does not 'blame' GPs for the rise in emergency admissions via A & E departments. There is an association between emergency admission rates and GP access so the study provides support for further investment in primary care to improve GP access.

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  • I wonder if there are statistics regaridng the increase in percentage/ numbers of GPs getting sued during this period.

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  • We have consistently found that, contrary to being risk averse and having a low threshold for admission, referrals from ED are far more likely to need admitting than referrals from GP. This doesn't apportion blame, as there will be many explanations for this, including self-selection by patients and the ambulance service for the sickest patients to come straight to hospital.

    However, the trite explanations that hospitals are doing it for the money, or the four hour wait, are ridiculous. Any activity above plan is paid at 20% of tariff, well below cost, and extra admissions put pressure on the system which increases the risk of breaches.

    We need to stop kidding ourselves that emergency admissions are going to reduce and plan instead to deliver safe care for the current reality.

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  • Having seen the figures, the biggest rise in admission via AE is th 18 - 35 age group.

    This is down to the 4 hour target. Patients with simple things like a UTI are close to 4 hours and are hence admitted 'on th computer' ie not taken to a ward.

    Unsurprisingly when you look at length of stay - the number of 0 day admissions has increased exponentially Over the last 10 years

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  • Having heard NHS England try to explain why surgeries with fewer extended hours slots(booked days in advance) is the reason for rising AED "I feel unwell I must be seen now" attendances I despair.
    Tribalism,Defend my budget,collude to agree the fault must lie with a third party not present in the discussion and gross inertia will destroy the NHS.

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  • Bob Hodges

    In lots of areas, A&E have placed themselves in harm's way by becoming the 'front door' where patients who've already been seen by a GP have to be sent. We have no choice in our area.

    You are then at the mercy of hospital coding when it comes to differentiating GP admissions and those who've just ricked up at A&E.

    We all know what happens when you rely on hospital coded data......

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