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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.’