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Lack of GP services not reason for A&E pressure, shows major study

Patients are not flocking to A&E because they can't get a GP appointment, but because they have long-term health conditions, researchers have found.

Appointment data from patients across east London debunks the myth that queues are caused by difficulty accessing a GP and suggested that GPs should not be used as ‘scapegoats’.

It comes after the Prime Minister was urged to apologise for blaming GPs for high numbers of patients visiting A&E last winter, and as NHS England mandated hospitals to set up a GP front-door 'streaming' service across all emergency departments this winter.

The study by Queen Mary University of London’s Centre for Primary Care and Public Health looked at two years of appointment data for 819,590 patients from 136 practices in Newham, Tower Hamlets and City and Hackney to explore why they went to A&E.

The study found that a fifth of patients visiting A&E had at least one long term condition and 2% had four or more. Deprivation also added to the effect, the study found.

In all, 30% of patients clocked up 505,868 visits to an emergency department, with three quarters of them going to a consultant-led major unit.

Of these, 15% were discharged to their GP for a follow-up appointment.

Lead researcher Dr Sally Hull said: ‘The pressures on emergency departments, especially during winter, are enormous. When departments are very busy, with long waits and difficulties finding beds for people needing admission, it is easy to seek scapegoats and suggest that poorly functioning GP services are to blame for the crisis.

‘Contrary to the popular narrative that people are using emergency departments rather than their GP surgery, our research shows that this is not the case,’ she said.

People who were frequent visitors to their A&E are also more likely to make more visits to their GP, while patients with low GP attendance also paid fewer visits to A&E.

‘The same people who attend their GP surgery a lot also attend their emergency department a lot. This is largely because they have multiple long term health conditions, both mental and physical, and it is these conditions, along with an ageing population, which are driving the high attendance rates,’ said Dr Hull.

The findings were welcomed by Dr Mark Sanford-Wood, the BMA GP Committee's deputy chair.

He said: ‘In the past some politicians have sought to blame overcrowding in A&Es on general practice, so it is positive to see further evidence showing that this is not the case.

RCGP chair Professor Helen Stokes-Lampard said: ‘General practice makes the vast majority of patient contacts in the NHS and by doing so we alleviate pressures on emergency departments, we don’t add to them. This research backs this up with important new data.’

She said patients also needed better information about the different services on offer so they get help at the most appropriate place.

Readers' comments (9)

  • Sick people need to be seen and treated. Rather than keep blaming different parts of the system for the problems politicians need to understand it is the deprivation and underfunding that causes the pressure. The system is a socialist ideology of free at the point of delivery trying to be run using capitalist business models of profit and loss. The two are incompatible and the country needs to be asked how much they are wiling to pay for their NHS.

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  • Blame it all on it being a Trumphole...........or Trumfol to be precise.........

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  • Joe is absolutely right. It is time to have the debate that no politician wants to have. Currently the NHS is expected to provide everything to everyone. At its inception I am sure that this was not anticipated, simply because we can do so much more and it is technologically more advanced and expensive. Politicians have expected somebody else to do the rationing!! We now need to have the debate starting with 1) How much are we prepared to pay and 2) What does that mean we can afford?

    If the population wants everything for everybody, the bill will go up exponentially and it is simply unaffordable. So far the NHS has survived on the goodwill and professionalism of the staff. Staff can only take so much. The sustained intensity of the workload will lead to burnout, and staff will leave. This at a point where more staff are needed. It was inevitable that at some point there would be a flu epidemic and that there would be a crash!!

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  • doctordog.

    RCGP chairperson does not seem to have grasped the ramifications of this study.

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  • Everything for free lasted about 3 years when charges for prescriptions were forced on a population in 1951...a population that was hoarding reselling and generally abusing the free commodity.

    Charges for other stuff should have come in every few years in the last 70...but didn't

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  • Know for years. Now its time to allow GP the time and resource to manage complex needs patients.

    I will not hold my breath ..............

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  • Excellent piece of work...
    now also look at the net benefit of immigration on the NHS when you look at the balance between utilisation and supply of services

    Why are some people so stuck on myths that simply aren’t true but sadly these are some of the guys who control policy at the same time!!??

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  • ...... 24 hour 7 day a week general practice...
    Need I say more.

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  • At our local A&E, anecdotally, over 99 % of patients attending are registered with a GP, so it must be those GPs fault that they attended, surely?

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