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GP access behind 'more than one-quarter of A&E attendances'

As many as 5.8 million people attended A&E in 2012/13 after failing to get a GP appointment, representing more than one in four of all attendances, researchers have claimed.

The research published in the British Journal of General Practice today suggests that, for every 100 GP consultations, there were 1.67 A&E attendances that were preceded by an unsuccessful appointment attempt.

But GP leaders have said that the conclusions are ‘engineered’ as they include walk-in centres in the definition of A&E, yet these are more likely to be used by young, fit commuters who have some acute problem and are less likely to use local GP services in core hours.

The study’s lead author also told Pulse that there were limitations to the study, including the lack of distinction between walk-in centres and A&E attendances, and said there was no way of measuring the clinical needs of the patients who attended A&E.

He added that the study was aimed at informing the debate over access, which has seen practices covering 7.5 million patients in England trialling extended hours schemes to improve ‘timely access’ and Labour leader Ed Miliband pledging to reintroduce the 48 hour target for GP appointments if they win the next election.

The researchers extrapolated their figures by using data from the 2012/13 GP Patient Survey and multiplying the 1.67% of people who said they had to attend A&E after an unsuccessful attempt at getting a GP appointment by the estimated 345.6 million appointments that GPs delivered in 2012-13.

These 5.8 million instances accounted for as much as 26.5% of the year’s A&E attendances, the study concluded.

Lead author Thomas Cowling, who is a doctoral research fellow at Imperial College London, said the analysis aimed to inform debate, and used national level surveys to estimate the numerical scale of the impact of GP access on A&E.

However speaking to Pulse, Mr Cowling explained that the research had identified several limitations.

He said: ‘The survey used in the analysis, the GP Patient Survey, doesn’t distinguish between visits to walk-in centres and those to other types of A&E department. Respondents are only able to select “Went to A&E/walk-in centre” as an answer to one of the questions (although walk-in centres are, officially, a type of A&E).’

‘Therefore, I’m not sure what proportion of the 1.6% concerns visits to walk-in centres rather than other types of A&E department.’

He added that the study was also unable to assess the ‘clinical need’ of patients who subsequently visited an A&E department.

Dr Peter Holden, GPC lead on emergency and urgent care and GP in Matlock, Derbyshire, told Pulse that reporting walk-in centre figures as A&E attendances would logically inflate demand, while the impact of the GP recruitment crisis could have made the issue more acute than when the survey was conducted, he said.

He told Pulse: ‘The survey itself is getting on for two years old, and that was before the recruitment crisis really hit us. GPs are under more strain now, and the bottom line is that counting walk-in centres is to try and engineer a story that you want, rather than find.’

‘The bottom line is, if you open up more lanes on the motorway you get more traffic.’

He added that walk-in centres were also used differently to GP surgeries or A&E saying: ‘It’s young, fit people who have some acute problem – like a urinary infection. They work in Derby, they live in Matlock. They choose to go there at lunch time.’

‘That’s not to say I’m not available, I am available, but if they choose to go there I can’t help them, that’s geographical.’

RCGP chair Maureen Baker said GPs were doing a ‘remarkable’ job with limited funding, and the results highlighted the need to fund local care, delivered by GPs.

Dr Baker said: ‘GPs are doing a remarkable job of treating patients in the community where care is most cost-effective and where patients want and need it most, this is particularly apparent in this research as the statistics include attendances at walk-in centres, many of which are staffed by GPs.’

‘Furthermore, research from the College of Emergency Medicine has shown that only 15% of attendees at A&E would be better off being seen by a GP in the community.’

‘But without the vital funding that general practice so desperately needs, the future for patients is looking increasingly bleak.’

The RCGP recently launched its ‘Put patients first: back general practice’ campaign calling for a greater investment in general practice to address dwindling workforce and support the transition of care from hospitals to the community.

Readers' comments (14)

  • Harry Longman

    This is a fascinating piece of research and a new way to look at the problem of the NHS as a system. Those making comments have an axe to grind - so do I. Let's be big enough to examine the evidence with open minds, and use it, for once, to inform policy and action.

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  • Azeem Majeed

    This articles (of which I was an author) provides further evidence for increasing investment and capacity within general practice and primary care. In recent years, we have seen the proportion of the NHS budget decline and this has adversely affected general practice.

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  • Azeem Majeed

    PS. The last sentence should be "the proportion of the NHS budget spent on primary care decline".

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  • My first 3 patients this morning was viral coughs of less then 3 days duration. 2 of them wanted to be "just checked over before going on a holiday" and another is a mom who walked out on me 2 years ago threatening to see another GP because I would not give AB.

    We don't have an access problem. We have a demand problem. Such research is useless as it tries to suggest a problem with access.

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  • Exactly
    The more you increase access the more rubbish you see
    why don't the powers that be see the non sense that they are responsible for!
    there needs to be demand management where the user has some responsibility for using the services appropriately

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  • Bob Hodges

    As we also know from OOH service, of those patients professing to 'have not been able to get a GP appointment that day'......a significant proportion are LYING. Plain and simple - they have not even tried.

    I have, on numerous occasions, had to triage my own patients OOH having been duty doctor that day.

    I agree, the problem is one of DEMAND and not particularly CAPACITY. The danger is that more capacity will create more demand if your solution is simply to create more capacity.

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  • This research very bad especially how the data is interpretated, I am shocked,only 1.6 percent of the population asked felt they had to go to Ae, that just proves gp providing excellent access, I mean how do the 98.4 percent of people manage then.

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  • It is a supply induced demand. Our public does not take responsibility.It is go the free gp culture.

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  • why are walk in figures included as A&E attendances?

    It seems fundamentally flawed interpretation will be pushed to the media!

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  • Vinci Ho

    My question is simple:
    Even though the findings were valid , do you really think this will 'persuade' a government to inject more commitment and hence funding into primary care OR
    a government could choose to interpret this as GPs were simply lazy.
    Think about the political consequence when one considers to publish one's study merely from an academic point of view .....

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