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Independents' Day

Study finds no evidence to support GPs in A&E wards

A major study has found there is not enough evidence to suggest introducing GPs in accident and emergency wards results in cost savings and reductions in overcrowding.

The Cochrane review of the effectiveness of having GPs in A&Es found that GPs used fewer healthcare resources than emergency physicians. However, it concluded that there was insufficient evidence to around the effectiveness and safety of the policy.

The review looked at three different studies – one from London and two from Dublin - from the mid to late 1990s which evaluated the success or otherwise of having GPs in A&E departments.

The studies involved a total of 11,203 patients, 16 GPs and 52 emergency physicians and in each case evaluated the effects of having GPs provide care to patients with non-urgent problems in A&E.

Two of the studies showed that having GPs in A&E departments resulted in fewer blood tests, x-rays, admissions and referrals.

In one study, GPs ordered 1,702 blood tests compared with emergency physicians, who ordered 2,939. In another, GPs ordered 2,303 compared with 2,381.

However, the third study showed no significant difference in the number of blood tests, x-rays or admissions but reported GPs doing a greater number of referrals and prescriptions than emergency physicians.

Despite the results, the review concludes that the evidence in the studies is not strong enough to say categorically if having GPs in A&E departments can lead to savings and reductions in crowding.

The report says: ‘None of the included studies provided data on patient wait-times, length of hospital stay, adverse effects or mortality. Overall, the evidence is of very low quality, the safety has not been thoroughly examined and results are disparate.

‘The evidence suggests that there is insufficient basis upon which to draw conclusions regarding the effectiveness and safety of care provided by GPs versus EPs for non-urgent patients in the ED.’

Dr Steve Kell, chair of Bassetlaw CCG and a GP in Worksop, said: ‘We did this a few years ago with not much impact to be honest.

‘To make it really effective you would need GPs in there when people are going to A&Es but that’s difficult for GPs as they have day jobs of course.

‘One thing we did find is that after six months of the scheme, the GP started behaving like an A&E doctor anyway. I don’t know of any evidence that it reduces admissions. We focus on making sure urgent care pathways are linked – particularly out of hours with A&E.’

Readers' comments (1)

  • Steve Kell is right- the dynamic is always :- "A generalist undertakes activity usually done by specialist, uses fewer widgets, gets caught by the rare exception case( that would have been picked up by the specialist usual custom and practice) and is quality manged into behaving exactly like a specialist thereafter."
    Specialist /generalist are complementary roles.
    "which is best" seems to me to be a chalk and cheese discussion, which has always smouldered on, historically fostered by overly self opinionated clinicans on both sides, currently fanned into a conflagration by a DOH that thrives on the ill willl and fractionation of the medical profession that results.

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