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Emergency admissions reduce when older patients see ‘regular GP’, report finds

Patients registered with GP practices that offer more accessible care and those who see the same GP over time are less likely to be admitted to hospital, new research has suggested.

The report published by the Health Foundation found that around 14% of all emergency admissions were for conditions theoretically manageable in primary care, while more than a quarter of unplanned A&E attendees had previously been unable to get a 'convenient' GP appointment.

It said there is ‘significant potential for impact’ in this area, and that improving access to GPs and reversing the ‘trend of underfunding and understaffing’ could reduce admissions.

This comes after the National Audit Office told NHS England earlier this year that it must make ‘measurable’ reductions in emergency admissions by 2020, despite warnings that it could 'create additional demand' for general practices.

The Health Foundation looked at trends in emergency admissions over the past decade, and found that the number of patients admitted urgently to hospital had increased by 42% over that period, while the number with five or more health conditions rose from one in 10 to one in three.

Alongside this, the cost of emergency admissions increased from £5.5bn to £17bn between 2006/07 and 2016/17.

The new research examined data for patients aged between 65 and 85 years and found that those who saw the same GP over time were admitted to hospital less often than those who didn't see the same GP as much.

It said that if older patients saw their most frequently seen GP two more times out of every 10 consultations, this would result in a 6% decrease in admissions.

The researchers also looked at the impact of extending opening hours and saw that patients registered to practices with extended access were 26.4% less likely to initiate A&E visits for minor complaints than patients at other practices.

Despite these reductions, this only equated to a 3.1% drop in A&E visits overall, and no information was available for admission rates.

Additionally, the report estimated that 26.5% of all unplanned A&E attendances in England were preceded by the patient being 'unable to obtain a GP appointment that was convenient to them', although comparatively few of these resulted in an admission.

The paper said: ‘Research has shown that patients who are registered at general practices that offer more accessible care experience fewer emergency admissions, as do patients who tend to see the same GP over time.

‘There is significant potential for impact in this area, as around 14% of all emergency admissions are for conditions that are, at least in theory, manageable in primary care.

‘Policies are now in place to improve access to general practice and reverse the trend of underfunding and understaffing, but they will take time to bear fruit.'

Health Foundation chief executive Dr Jennifer Dixon said: ‘Some of the increase is because the NHS is able to keep older and sicker patients alive for longer, who then return to hospital. However, it could also suggest that health and care support in the community is not as good as it could be.’

Royal College of Emergency Medicine president Dr Taj Hassan added: ‘It is high time decision makers gave up on futile redirection schemes and planned for the demand we have rather than the demand that is hoped for.

‘We must ensure we have sufficient numbers of senior decision makers in emergency medicine and improve ambulatory care pathways, as well as access to appropriate services in the community, in order to effect safer discharge.’

Research published last year found that patients who see different GPs from visit to visit are more than twice as likely to be admitted to hospital.

The study looked at 10,000 patients aged over 65 from nearly 300 GP practices, and found that older patients who see the same or a small number of GPs are at a reduced risk of emergency hospital admissions compared with those who do not.

Researchers suggested that plans to enhance continuity of care could reduce hospital admissions.

 

Readers' comments (14)

  • What abou tif they use the same computer os app.

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  • Aaarrrrggghhhh!!!! I feel like I’m living in the twighlight zone or going mad! So what those experts, on the ground, have be screaming for years, has proved right! But instead we want complex elderly patients to do a merry go round of locums, ANPs and any other provider who doesn’t know them and they don’t trust! I can’t carry on with this......

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  • Vinci Ho

    Ha ha ha
    It is just because political parties ( and their propaganda media machineries) refused to accept how important general practitioners(particularly partners and non-locum GPs) are to NHS , this resulted in unnecessary going-around-the-circle debates and researches which eventually led back to the starting point . Waste of efforts and resources!
    The value of Continuity of Care (COC) is undisputable but only if we have the right amount of resources , particularly manpower and time .
    Ignoring these fundamentals , politicians are digging a grave for NHS and for themselves (since majority of the people/voters in this country evidently care about NHS very much) . On its 70th anniversary , NHS is at a state totally self-inflicted by these despicable politicians. (Yes, I am ranting, whether you like it or not!).
    The ideology of working by scale is entirely an over-compensation because our resources are starved to bare minimum. Hence , it is a mechanism adopted to adapt to the reality which was never satisfactory, in my opinion .
    More and more GPs are leaving and less to join in , this is our natural ‘protest’ to these leaders , technocrats and politicians who are lacking vision and insight of exactly how NHS could have delivered .
    Is it too late now? I don’t have an answer . But I know my slogan/soundbite is right , ‘ the government needs GPs more than they need it.’

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  • Cobblers

    Rock on 6:48pm.

    Veni, Vidi, Vinci. (Well Caesar might have said it if alive now)

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  • ‘But extended hours’ Jeremy Hunt might say.

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  • Knowledge is Porridge

    Working at scale was always a false promise to stop failing practices throwing in the towel. While weekend and evening work is trying to get more work without more infrastructure funding. It's a tough thing propping up primary care without any funding to support it. We could save lots with some tough choices, but the toxic legal environment makes us afraid to do the right thing...

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  • Primary care needs recognition for impact on system, via adequate funding and maintaining the small practice model - it works

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  • Took Early Retirement

    But soon there won't be the partners to provide continuity. I see there is another "private" provider failure in Reading today too.

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  • What can you say about this other than it will be ignored as they scratch around trying to figure out a quick fix to emergency admissions. Past caring.

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  • Scrapping seniority and pension changes is not helping

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