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Independents' Day

Extended GP opening has 'no immediate correlation' to A&E use, CCGs find

Geography seems to have more impact on the number of patients attending A&E than extended practice opening hours, CCGs have found.

A report publishd by NHS Mansfield and Ashfield CCG and NHS Newark and Sherwood CCG said there was ‘no immediate correlation’ between extended hours and the number of people turning up to A&E.

The CCGs looked at attendance records between August 2016 and July 2017 for practices offering core hours only and practices with extended hours (including both via the Extended Hours DES and CCG-commissioned extended access).

Primary care manager Paula Longden, who wrote the report, said geography seemed to have more of an impact on patients heading off to A&E, rather than extended practice hours.

She pointed out that three out of four practices in Newark offered extended hours commissioned as NHS England’s direct enhanced services yet had red-rated A&E attendances.

By contrast Sherwood practices which only offer core hours have low A&E attendance,.

In Kirkby, practices offering both NHS England-commissioned and CCG commissioned-extended hours had lower rates of A&E attendances.

The report concluded that there was 'no immediate correlation between GP opening hours and the weighted rates of emergency department attendances'.

It said: 'This suggests that geography plays a significant part in influencing patients decisions about which healthcare service they access.'

But the CCGs said this comes despite a patient survey, carried out by the CCGs in February, finding that 22% of patients went to A&E because they could not get an appointment with their GP.

The CCGs are starting to offer extended GP access throughout the entire area from October, and the report suggests the CCGs should promote the service to patients to ensure take up.

The CCGs are part of an NHS England new care models pilot area, testing the hospital-led primary and acute care-system model of integration between community and hopsital services.

The rollout of seven-day routine general practice

It comes as a report on winter pressures presented at NHS England's board meeting this week said that extended GP access will be available in 'twice as many' CCGs as last winter, including across the whole of London.

In all, it says '50% of the population' will have access to routine evening and weekend GP appointments this winter.

As of 2019, all CCGs will receive £6 per patient to roll out evening and weekend appointments across England.

Pulse revealed earlier this year that seven-day pilots have been set a target of filling at least 60% of appointments, with those falling short asked to submit plans on how they will boost demand.

And a recent Pulse investigation revealed that many Sunday GP appointments offered as part of the Government’s election manifesto commitments are going unfilled, heaping pressure on standard hours care. In one area, just 2% of appointments were booked up on a Sunday.

Readers' comments (12)

  • Bleeping Dr Ivan Bennett to A&E please.

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  • are we not looking at this the wrong way - surely we should be asking are all these appointments actually needed - when i worked at a WIC over 60% of people seen could have self managed or just used advised and meds from a supermarket pharmacist, most sundays I worked in UCC were quiet and even less used for routine appointments. Having worked in both rural and inner city practices, patients won't go to A&E if if too far for a minor illness, they will if its next door. I have had patients triage for an emergency appointment, told it will be in 2 hours time and they have replied this was too long and went to A&E instead to wait to be be seen by a triage nurse after a 3 hour wait and told to go home. Patients lie on surveys - and to us all the time, we have known this for years as doctors. so perhaps what we should do is say if you have a nhs card - this entitles you to 6 GP appointments a year for a new problem, attendance at A&E counts as two appointments, this does not include screening, vaccination and chronic disease appointments nor follow up appointments as recommended by a GP or nurse. If you DNA you lose one of the 6. After you have used the 6 slots you pay for your appointments and if you book and DNA you pay for that as well. most normal people will never get to the 6 slots in a year, those who abuse the service will end up paying for it. Discretion can be used by the GP for patients such as though with cancer, chronic disease or psychiatric illness who made need more slots and thus should not pay for extra slots but this should be the GP decision based on clinical need. No nhs card - you pay. Extra cash could be given to charities to cover the homeless and unregistered so they can access services if entitled. I have worked in canada where patients get charged all the time by GPs if not covered, its not difficult to do. walk in clinics just encourage abuse of the health service - i really do not need to see someone who has had a sore throat for 60 minutes - this is not a joke either. the time saved could then be spent on people who are actually ill and get the help they need and need longer appointments.

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  • d in vadar @10.47

    Totally agree.

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  • Even if it did it doesn't matter. A few sore throats and a vomiting kid turning up at ED ain't going to crash the system. Focus needs to be on frail elderly.
    For 15 years I have done weekend visits for the ooh service. 15 years ago I was admitting elderly with social issues to acute hospitals and still today I am doing the same as there are simply no viable alternatives.

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  • Can anyone tell me why the presumption is that the extended hours are offering extra appointments? Surely they are spreading the same resource more thinly. (I know they are supposed to be extra, but they are taking our daytime locums)

    And separately, if the A+E attendance rates are linked to being able to get an appointment with your GP (as we are often told), how extended hours fits in with this? Surely it is the availability of appointments, not the timing of them per se, that matters?

    Wouldn't it make more sense to provide funding for more daytime cover?

    Oh yeah, but that would be logical, and not appeal to the London-centric politicians. Silly me.

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  • Newark's A/E figures are high as they count attendance at the MIU as A/E. There has been a strong 'save Newark Hospital campaign for years with 'use it or loose it message'. Newark has a high eastern european population who just turn up at the MIU when the surgery is closed. For many of our patients the hospital is closer to their homes than the surgery is. We offer lots of appointments including extended hours and unlimited same day access for urgent issues....A/E attendance is not related to inability to access a GP

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  • Just Your Average Joe

    National DOH led education campaign needed to encourage self care - however if anyone gets seriously ill or dies - this would open up DOH to being sued.

    Much better to let GPs take the risk of trying to reduce demand as we pay our own ramping up indemnity - so DOH gets to blame GPs for A&E attendances as well, w3in/win for them.

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  • Maverick

    Breaking news BBC 1.10.17.... Prof Ted Baker (chief hospital inspector) finds NHS not fit for the 21st Century. Chronic underfunding and lack of foresight...
    Well knock me down with a feather...
    Now, at last it's in the public domain

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  • AlanAlmond

    proud cardigan | GP Partner/Principal30 Sep 2017 10:13pm

    Can anyone tell me why the presumption is that the extended hours are offering extra appointments? Surely they are spreading the same resource more thinly.

    Abso-bloody-lutly. When I do extended hours my afternoon shift is cancelled and I just do a late shift instead. And who does this benefit? Well it's the same people I would have seen in the afternoon only they are all pissed off they had to wait till 7:00 to see me. It's BONKERS!

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  • Dear All,
    Ground breaking revelation uncovered by CCGs, really? Or long known fact based on the bl**din obvious but an inconvenient truth for policy makers and thus best ignored. Hey guess what, A/E attendances also linked to TV programming schedules. The real question now is will this CCG now do the right thing and pull the plug on its extended hours services and re-invest the resources into daytime general practice so they can have more docs and staff to deal with normal hours work?

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