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Seven-day GP services 'reduced A&E attendances by 26%'

A flagship seven-day GP access scheme managed to reduce A&E attendances for minor injuries, but at ‘significant costs’, a major new study has revealed.

A study by researchers from the University of Manchester reveal that the Greater Manchester seven-day pilot scheme reduced A&E attendances for minor injuries by 26% in its first year.

However, this amounted to £768,000 worth of savings – compared with costs of £3.1m - despite the intention that the schemes would be cost-neutral.

The authors of the study said that the services are useful in reducing pressures on hospital services, but this came at 'significant costs'.

The GPC said that this study was more evidence that spending scarce funds on a ‘luxury’ like extended routine GP access was ‘indefensible’.

The analysis – which encompasses 56 practices and 346,000 patients – found that the programmes across Manchester had led to 11,000 fewer cases of patients turning up at A&E departments with problems that could have been handled by a GP.

This represented a 26% reduction, which was far greater than the 3-8% reported in a Department of Health commissioned analysis of the same schemes last year.

The researchers said their statistical analysis was ‘significantly stronger’ than earlier studies, and predicted the reduced attendance at A&E amounted to a 27% reduction in costs for treating minor injuries – or £767,976 in 12 months.

But this was only achieved after the four access programmes in Bury, Heywood, Middleton, and Central Manchester had received combined funding of £3.1 million.

The paper, published today in PLOS Medicine, states: ‘Health benefits may accrue due to extended access to “out-of-hours” primary care or via better timeliness of care; alternatively, benefits may not accrue should extended access result in substitution of appointments during routine open hours.’

But it adds: ‘We find the intervention led to a cost reduction in emergency department use of £767,976 the incremental cost is therefore £2.3 million. The intervention would therefore need to see significant health gains to be cost-effective.’

However, it also concedes that being unable to ‘disentangle’ set-up costs and running costs means it may ‘over-estimate the long-run cost of the scheme’ and that any benefits wouldn’t necessarily translate outside of Manchester.

The paper’s lead author William Whittaker, a research fellow in health economics at The University of Manchester said there was a need for evidence on the benefits to patients because ‘on the basis of emergency department savings alone, extending primary care is unlikely to be cost-effective.’

He added: ‘Our study suggests that extending opening hours in primary care may be a useful addition to policies aiming to reduce pressures on hospital services, potentially reducing patient-initiated use of the emergency department for minor problems—but at a significant cost’.

Mr Whittaker told Pulse their results had highlighted a great reduction in A&E attendances than the DH study because they focussed on ‘patient initiated’ visits, and used a more appropriate comparator group of practices who hadn’t extended access.

GP leaders said that the study was more evidence that the NHS couldn’t afford seven-day GP access.

GPC deputy chair Dr Richard Vautrey told Pulse: ‘If the NHS was awash with cash then extended surgery hours may be a luxury worth spending money on, but at a time when really tough decisions are being made about rationing basis services and closing others, to continue to waste valuable NHS funds in this way for no discernible benefit but just to fulfil a political target is increasingly indefensible.’

The Department of Health has been contacted for comment.

How the Manchester pilots paved the way for seven-day services

Manchester - online

Manchester - online

The Manchester pilots were the first wave of former Prime Minister David Cameron’s flagship ‘Challenge Fund’, which got off to such a strong start that the NHS Central Manchester CCG’s scheme was hailed as a success before it had even begun.

It received additional funding to extend it into 2015 despite doubts about the savings it could deliver already being raised in its first year.

The rollout of the seven-day scheme nationwide has seen NHS England pledging £500m a year to CCGs to commission seven-day routine GP access across England earlier this year, and Jeremy Hunt reaffirming a commitment to seven-day GP services despite David Cameron’s resignation.

And, as revealed by Pulse, NHS England is providing ongoing funding to all of the Prime Minister’s seven-day access pilots after their funding has run out, despite plans for them to become self-sustaining by cutting the number of A&E attendances at weekends and evenings.

An official interim evaluation of GP extended access recommended Sunday opening is ditched due to a lack of demand, with the potential of commissioning extended evening opening or Saturday morning clinics.

Pulse has reported that almost half of the Challenge Fund/GP Access pilots have already reduced opening hours, amid lacking patient demand and uncertainty over future funding.

Read all about the seven-day scheme on Pulse’s dedicated page

Readers' comments (20)

  • so it cost £3 m and it saved £700 K. I am sure it will be announced as a triumphal success and a prove that this governement's plans for 7 day NHS is working, and it will be rolled nationally next month.

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  • I think 9.38pm has pretty much hit the nail on the head. My fear is the government will force through a contract whereby we work weekends essentially for free to help A&E. Just like the junior docs contract.

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  • Vinci Ho

    (1) Sheer egoism from DC and JH. They want to be remembered in history as the groundbreaking politicians to introduce the first in the world 7 days GP opening ,at ALL costs.
    (2)Aesthetic enthusiasm - go for perfection at ALL costs , 7 days opening is 'beautiful' . Everybody would love it
    (3)Historical impulse - JH believed he found the 'truth' and sign of the times ,about so called weekend effect associated with the higher number of death in hospital admissions.
    (4) Political purpose - obviously.

    Thanks to GO's enlightenment , I concluded politicians are worse than writers :
    y public-spirited. All politicians are vain, selfish, and lazy, and at the very bottom of their motives there lies a mystery. Writing a policy is a horrible, exhausting struggle, like a long bout of some painful illness. One would never undertake such a thing if one were not driven on by some demon whom one can neither resist nor understand. For all one knows that demon is simply the same instinct that makes a baby squall for attention. And yet it is also true that one can write nothing readable unless one constantly struggles to efface one's own personality.

    Inspired by George Orwell 's 'Why I write'.

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  • wheres ivan now?

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  • Dear All,
    So the basic facts are; spend £4 to save £1.
    Again just in case the acolytes didn't quite get the message SPEND £4 to SAVE £1.

    And; the GPs doing the lucrative weekend Prime Minister's sessions were poached from the GP OOH services and weekday locum pool, it gets even better.
    Regards
    Paul C

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  • Dear All,
    Oh and i forgot to add that all the evidence in capacity in unscheduled care is that any initial diversion soon disappears, extra availability will be all consumed. A/E attenders will realise A/E is 26% less full so will spread the word and the GP sessions will soon get filled. Lets do it again in 3 years time when i predict we wil find A/E up to their previosu levels and the GP sessions also fully booked. then it will be spend £4 save nothing.
    Regards
    Paul C

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  • Ivan got out in time

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  • in other words this 7 day scheme is an absolute disaster and criminal waste of nhs taxpayers money
    it must therefore ..if politicians were not so vain and incredibly thick and ignorant/arrogant and fail to heed facts..be instantaneously liquidated.
    end of
    ?or do the perpetrators of this insanity want to explain to their parents one of the reasons they are waiting so long for essential treatment is because they are pissing nhs money into the wind of their own vain arrogance.(in fact the urinary streams of the stupid waste are in the hundreds)
    mr runt and mr stevens..RESIGN NOW.

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  • @Editor - please amend the headline, because it should focus on the massive waste, rather then 'reducing a+e attendance'

    if they pumped 3m into a+e or gp-land proper then they wouldnt need such vain projects. again, ivan has been strangely absent.

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  • I think the key thing to note is that the 27% reduction in costs are for treating MINOR INJURIES. GP Surgeries are never going to be the best place for this, stop closing MIU's and focus on making the best use of them instead.

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  • Yet again focussing on the wrong problem. Just need to commission appropriately where patients access healthcare either the GP if perceived non-urgent or A+E if perceived urgent. Stop using patients as the problem in the system it is the system that has to change to manage the publics expectations and the politicians to fund those expectations!.

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  • Great! More choice of work.

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  • The comments on here have missed one point. 7 day working is not just about reducing A&E but about adding capacity to general practice. I don't know about you but our practices are at breaking point, cannot recruit or provide any more capacity - so this service really helps.

    Feel free to hit me with Pulse negativity!

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  • Took Early Retirement

    Yes, IIRC Ivan was an advocate of this sort of thing.

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  • @4:18 - the same appointments could surely be provided more efficiently during the week - if the funding was there instead.

    The people doing the weekend shifts are not the same ones working 9 sessions during the week. Removing them from weekend and providing more funding during the week means that instead of a 15 patient clinic session on a Saturday - they will do an 18 patient clinical session + 2 visits + review blood tests + follow up letters during a clinical session in hours, in a GP surgery.

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  • Just print more money Quantitative Easing... The NHS is too big to fail...
    Like the banks

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  • Says it all...about NHS funding
    when the staff have to set up a tea coffee fund

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  • £768,000 worth of savings – compared with costs of £3.1m !!!

    Good Job!!

    Good Will HUNT -ing !!!

    At this rate soon we will soon have so much money left that we wouldn't know what to do with ourselves!!!

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  • Wow!! It is like - The operation was successful but the patient died on table!!!

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  • Vinci Ho

    Let's be fair and honest about the arguments and evidences so far:
    (1) Any arrangement to increase capacity with more patient appointments outside individual practices will help AS LONG AS it is funded properly by any way. This is the same argument why probably many of us including myself had no problem about the Uber style GP appointments set up by our London colleagues especially in this desperate times and if patients are willing to pay. Though my concern was whether some patients would still have to go back to their own GPs later for certain issues. Of course , these Uber GPs had no access to patients' medical records.If the interpretation of this document is about delivering these additional GP accesses mainly by some local hubs and of course , super or mega-practices , one will presume new IT systems will have to set up in all these hubs to access full or near-full patient's medical record . So there is a set up cost for generalising to cover all areas .
    (2) The Vanguard sites and hence pilots(Cameron/Hunt methodology)were established in high profile with 'good' funding over a fixed period of time and was only extended under the pressure of negative receptions. The original ideology was , if I remember correctly from comments from protagonist(s) , the scheme would ultimately become 'self sufficient' because of saving in secondary care. Then let's look at the evidence recently reported in here:
    ''The researchers said their statistical analysis was ‘significantly stronger’ than earlier studies, and predicted the reduced attendance at A&E amounted to a 27% reduction in costs for treating minor injuries – or £767,976 in 12 months.
    But this was only achieved after the four access programmes in Bury, Heywood, Middleton, and Central Manchester had received combined funding of £3.1 million.
    The paper, published today in PLOS Medicine,states: ‘Health benefits may accrue due to extended access to “out-of-hours” primary care or via better timeliness of care; alternatively, benefits may not accrue should extended access result in substitution of appointments during routine open hours.’
    But it adds: ‘We find the intervention led to a cost reduction in emergency department use of £767,976 the incremental cost is therefore £2.3 million. The intervention would therefore need to see significant health gains to be cost-effective.’''
    (3) So , a logical question, 'Is £6 per head enough and how do you arrive with this figure?' This also leads to questions as far as the design of these pilots are concerned :Should there be arm to arm comparison where the same amount of 'pilot' money was given to locally existing Out of Hours providers or even just to all the local practices to increase capacity ,hence appointments, in just keeping normal hours opening . I am afraid the ethos and telos of conducting a proper pilot study was deliberately obscured by Cameron and Hunt in here , exploiting the passion of those protagonists.
    (4) I concur that this extended access, if funded properly , is to create more job opportunities and clearly , the concern that it would be difficult to get doctors to fill these sessions appeared to be non-existing according to colleagues involved in these schemes. But it also begs the question of simply how much are you paying them for the sessions?Again, if the same amount of money was given to local OOH services in another arm of the pilot study, the conclusion could be different .
    (5) Finally,how 'new' is this £6 per head? If this is another smoke screen for CCG making more cuts from somewhere else , whether in primary or secondary care , the detriment will only come back to general practice on the big picture. The most interesting question remains, as I alluded earlier on , how big is the impact of these 'new' job opportunities created will have on the equation of preventing experienced GPs from leaving and attracting substantial amount of new bloods?

    The truth is the truth and is still out there . It cannot be replaced by 'something like the truth'

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