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A faulty production line

Merging practices into larger centres could increase A&E visits, finds study

Patients living closer to an A&E department are more likely to choose it over their local GP practice, according to a survey of the social influences driving people in deprived areas to A&E.

Researchers from the University of Liverpool conducted the survey in 20 disadvantaged neighbourhoods across the North West to understand why people go to A&E.

They found access to GP practices is ‘a unique determinant of A&E attendance’, and suggested consolidating practices into fewer and larger centres could therefore increase the number of visits to A&E.

The researchers collected the views of 3,510 residents across Lancashire, Cheshire and Merseyside, who provided information about their ‘physical health, mental health, lifestyle, social issues, housing, environment, finances and local health service usage’.

The paper, published in BMJ Open, said: ‘Living further from an A&E department reduced the likelihood of attending an A&E service by 7% per kilometre, and living further from a GP increased the likelihood of attending A&E by 46% per kilometre.’

‘The results indicate that primary care access predicts A&E attendance over and above the effects of health status, socioeconomic status and A&E access,’ it said.

Improving public transport links and locating practises in areas with high A&E attendance could bring rates down, the researchers suggested.

While they found living further from a GP practice encouraged more trips to A&E, the researchers also pointed to other contributing factors.

They noted that age was a factor, with 18-26 year olds being three times more likely to visit A&E, compared to those aged 64 and over.

Unemployment, depression, and a need for help with personal care were other factors that were highlighted.

Study co-author and research manager at the University of Liverpool Dr Clarissa Giebel said: ‘This is one of the first surveys to explore a comprehensive set of socio-economic factors, as well as proximity to both GP and A&E services, as predictors of A&E attendance in disadvantaged areas.

‘Inequalities around employment and housing are an important part of understanding the motivations for attendance levels and there is a clear need for closer consideration of the placement of primary care services and ensuring clearer public access routes to them.’

Earlier this month, researchers warned there is little evidence to suggest larger GP practice list sizes boost clinical outcomes or save money.

In a paper published in the journal Health Policy, researchers found trade-offs and unintended consequences mean the expected benefits from scaling up GP practices are hard to see on the ground.

They recommended NHS England take caution in rolling out such plans and pay close attention to unintended consequences.

A version of this story was first published on Pulse’s sister publication Healthcare Leader.

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Readers' comments (8)

  • Vinci Ho

    Common sense prevails.
    This has not proved anything more than what we all know deep down . But it simply demonstrates how much more NHS needs ‘adequate’ numbers of general practices scattered through districts . Scaling up the size of surgeries stifling resources to smaller practices , is purely an economical ideology, which might bring short term financial gain . But on long term , it is a totally short-sighted and shallow concept .
    I totally understand why colleagues went merging themselves into bigger practices for survival. Bottom line is the successive governments are unforgivable simply by creating a hostile environment for all of us (GPs)

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  • It also means that people are lazy and go wherever is most convenient- which will only be stopped by charging them for attendance

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  • Bob Hodges

    Stop pandering to them by seeing them if they don't make the 'Accident and/or emergency' criteria. The clue's in the sodding name.

    Doctors aren't going to take this responsibility on without political we're stuck with it.

    Just build bigger A&Es.

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  • Big surprise. People will just go to the closest place for services. The e referral system touting patients have choice by Labour. Almost all of my patients choose the local hospital. Fuel is not cheap.

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    Several appointments at various locations with staff of various skill levels
    - Collusion of anonymity
    - Loss of continuity
    - Increasing patient
    - Exacerbation of condition
    - End result A+E..
    - Discharge ASAP..
    - Chronic issues
    sent back to GP
    Repeat cycle..

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  • David Banner

    Re Gen Prexit

    “Collusion of anonymity”- wonderful phrase, perfectly sums up the pass the buck mentality of the modern NHS, where continuity of care has been sacrificed for short term gain.

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  • Northwestdoc:- People are not lazy they are just frustrated and disillusioned with what many GP's consider a service but is in fact anything but.
    See them(GP patients) in A+E, use the facilities, X ray, bloods etc sort them out at a one stop shop not multiple (almost impossible to get) GP and nurse appointments with multiple locums/ANP's/PAM's this is the 21st century, Dr Finlay died yrs ago.
    Primary (sometimes) care(s) is moribund if not actually dead in the UK.

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  • Like this is new news? We knew this 30 years ago in my area, a direct correlation between distance from A/E and rates of attendance. Damn, I should have published the data!

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