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Locating GPs in A&E 'increases demand and doesn’t save money'

Co-locating GPs in urgent care settings increases patient demand, and the set-up costs are far greater than the marginal savings made, according to a study published in Emergency Medicine Journal.

The researchers from the University of Sheffield found that the presence of GPs was linked to an increase, not a decrease in emergency care demand, concluding ‘if you build it, they will come’.

The study - which reviewed studies from around the world on unscheduled care from hospital-based GPs between 1980 and 2015 - found that the set-up costs were very high, with only marginal savings from the co-location.

The authors also warned that co-located services could increase staff dissatisfaction and reduce the quality of care.

They said: ‘By blurring the line between emergency and primary care by co-locating services, there is a risk of losing the continuity of care that primary care provides, and encouraging ad hoc health seeking behaviour.’

They add that ‘patients are generally good at deciding where to access care, and inappropriate choices are generally a function of complex socioeconomic factors and shortcomings in the unscheduled care system.’

It has been previously claimed that GP-led urgent care centres can deal with three-quarters of attendances and the Royal College of Emergency Medicine has argued that GP out-of-hours services should be based in every A&E department so patients could be triaged to the appropriate service to reduce demands on A&E.

However, the authors conclude: ‘There are significant and unexpected consequences of simply transferring interventions that work in one setting without an understanding of context and the process of change’.

Readers' comments (8)

  • What's new here? ANY improvement in access always increases demand. Time to stop improving access and to start reducing demand. First step is to start charging service users's for appointments.

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  • However, the authors conclude: ‘There are significant and unexpected consequences of simply transferring interventions that work in one setting without an understanding of context and the process of change’.

    Unless of course it is dumping huge volumes of secondary care without funding into primary care. That's ok.

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  • If you co-located GPs in A&E, but charged them the A&E rate (ie more) they would all go to their own GP - done.

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  • Of course it doesn't work as the patient can then decide to go to A&E when they can't get want they want from their GP. You can't have GP surgeries and A&E both trying to provide urgent primary care. If you are going to create supply in A&E you have to turn it off somewhere else.

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  • bear...poo...woods

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  • I worked in an early pilot as a GP in a&e and it never made any economic sense to me - I would spend 5 hours seeing earache and back pain, which otherwise would have been seen by the SHO at a much lower hourly rate than mine! How could that save money?

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  • Bob Hodges

    The only solution is given A&E the balls to tell people to 'sod off'.

    Instead, we set up entire hospital trusts to see A&E attendees in 4 hours, when one third could wait 4 days without coming to harm and one third should wait as long as 4 hours.

    The politically motivated, evidence free, tail is wagging the secondary care dog as usual.

    If up to 30% of attendees don't need to got to A&E, that's not the same as '30% of attendees need to see a GP instead'.

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  • In any other sphere of life, setting up a service which is popular and used would be seen as success. The system is so complex that it is impossible to interpret studies like this - what was the effect on local practices, did the GPs refer/prescribe less etc.

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