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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