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Pressure on emergency services due to soaring attendance at minor A&E and walk-in centres

Patients presenting at minor A&E departments and walk-in centres are behind the rising pressure on emergency departments, claims a new analysis by NHS statisticians.

The analysis - published today - found that overall A&E attendances rose by 22% in England between 2004/05 and 2012/13, while the population grew by just 6.6%.

The figures showed there were 11,000 more A&E attendances per day last year compared to the year the new GMS contract was negotiated – which health secretary Jeremy Hunt blames for rising pressures on A&E departments – growing from 49,000 to 60,000 attendances per day.

But the report from the Health and Social Care Information Centre (HSCIC) found that attendances at minor (type 3) A&E departments, urgent care centres and walk-in centres were responsible for the largest proportion of the rise however, rising at 11 times the rate of the population growth in England.

In comparision, the rise in attendance at major (type 1) A&E departments have only ‘risen slightly’ above the rate of population increase in England, concludes the report.

The report also shows a rise in the proportion of patients being given ‘guidance and advice only’ as a first treatment, from 25% in 2009/10 to 34% in 2012/13 - although HSCIC sid that this ‘could be accounted for by an improvement in data quality’.

The Government said it was tackling the growing attendance rate by handing GPs a ‘named clinician’ role for the elderly from 2014/15, however the statistics did not seem to draw a strong link to the elderly population, as 55.5% of all attendances last year were for people aged under 40.

Only for major departments treating more serious health episodes attendances did attendances grow by over 64s since 2004/05, however only by 2.6 percentage points.

Meanwhile, users of mental health services were more than twice as likely to have attended A&E than non-users and were also likely to attend more frequently and the report also drew a link to deprivation.

Health minister Lord Howe said: ‘A&Es are performing well and meeting national targets, despite seeing more patients. But, as these data show, we know there’s more pressure on the system and we’ve taken action to address this.

‘We’re investing £400 million in measures to relieve short term winter pressures and, longer term, we’re integrating health and social care and bringing back the link between GPs and elderly patients, to enable more people to receive the treatment they need away from A&E.’

But GPC deputy chair Dr Richard Vautrey said: ‘These figures confirm yet again what we have been saying. Major A&E attendances have only slightly increased but, like GPs, they are seeing older and sicker patients.

‘The four-hour target is doing patients a disservice and it is time it was scrapped. It is not a good assessment for the quality of care provided by A&E and has become an unhelpful political football which is potentially damaging patient care.’

BMA chair Dr Mark Porter added that the Government’s botched rollout of the NHS 111 emergency care number had not helped the situation.

He said: ‘The disastrous introduction of NHS 111 replaced a clinician-led service with a call centre and was responsible for many people being wrongly directed to emergency departments.’

Meanwhile, Andy Burnham, Labour’s shadow health secretary, said the 2012/13 A&E statistics were ‘embarrassing’ for the Government.

He said: ‘They have diverted attention from the real causes of the pressure and allowed this crisis to deteriorate, putting spin before patient safety in an appalling abdication of responsibility.’

Professor Keith Willett, director for acute episodes of care at NHS England, said: ‘The data published today by the Health and Social Care Information Centre cover much of the same areas as those analysed by NHS England in setting out the evidence base behind our vision. We know that too many people are attending major A&E units when they could have received advice or treatment equally well out hospitals, from GPs or at urgent care centres, from paramedics or from pharmacists, had those options been more  available.

‘We know that systemic change is needed across our urgent and emergency care system, so that all aspects of the health and social care system from major illness, trauma and mental health crisis, through to minor ailments and the management of long-term conditions, do work together to get the best and most appropriate help to people first time.’

Readers' comments (6)

  • Its like opening up another lane on Motorway: If its there It will get used

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  • What is the increase in patients seen daily in General Practice over the same comparison period? What is the increase in staffing levels in A&E over the same comparison period? How many more/less Drs are now employed in A&E? How many beds have been closed over the same comparison period. What has happened to GP funding as a proportion of spend over this comparison period? Seemingly the only important consideration is that workload (but not funding) is transferred to primary care.

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  • Dear Pulse
    What are the figures for GP consultations during this time?
    If the 22% rise can be accounted for by a corresponding fall in the number GP consultations in this same time; we can all say sorry for all that money we're earning for doing less.

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  • Over and over - the media and the likes of Mr Hunt and his lieutenants such as Sir Bruce, Willet, keep telling the public that patients need to directed to the GP. This PR tactic from Mr Hunt -' the buck does not stop with me' man is just annoying - My ( 10min appt) 3hr surgeries every day are packed and this does not include visits and end of surgery advice calls. It is the demand that needs to be tackled - the supply is limited and shrinking as more doctors consider leaving, retiring, go part-time esp the female colleagues- etc.

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  • Vinci Ho

    Dear Agent Hunt
    So a lot of patients 'walked in' Walk in Centres. But they are costing a lot of money as well as being created by last government (always evil in eyes of current government ) . Hence , together with NHS Direct , they MUST be destroyed . Move all these patients to their 'stupid and lazy' GPs by (1) finishing off their independent status (2) forcing them to work 24/7 , 7 days a week. You can then cut even more cost in A/E.
    Your prize of achieving this could be the next Chancellor of Exchequer or even the Prime Minister

    This message will self destruct in 10 seconds.

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  • If the data the HSCIC is given is anything like as reliable as the rubbish data we get given to analyse regularly.......

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