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Seven-day GP working shows ‘significant’ reductions in A&E attendances

Seven-day GP access pilots have brought significant reductions in the number of A&E attendances and admissions, but might be most effective in ‘strategically located surgeries’, researchers have claimed.

The study by the University of Sussex, published in the Journal of Health Economics, found that seven-day opening did little to divert A&E attendances for minor injuries, but it was effective for older patients and more affluent patients.

A&E attendances were reduced by 10% across the week among patients whose practice was piloting seven-day access, with reductions of 18% seen on Saturday and Sunday.

But GP leaders have called for caution in interpreting the study, which contrasts with others – including the Government’s own assessment – which found Sunday opening was less popular.

Researchers looked at 34 practices in central London, some of which have been piloting seven-day working since 2013 – before the national seven-day access pilots funded by the Prime Minister’s Challenge Fund.

Pulse has revealed that a quarter of practices in the national Challenge Fund pilot have curtailed opening hours, or stopped all together, because of a lack of demand.

The access pilots were also meant to become self-funding by freeing up funding from more expensive hospital attendances, but NHS England has had to plough more money into schemes to keep them operating. 

And a further £500m was pledged to support the rollout of seven-day access in the GP Forward View.

The study states: ‘We found a large and statistically significant reduction of 9.9% in A&E attendances overall and 17.9% in weekend A&E attendances by the patients registered at the pilot practices.’

It found a similar drop of 10% in hospital admissions, which was ‘entirely concentrated among elderly patients (over 60 years of age).’

Researchers speculated that hospital consultants without access to the full record were more risk averse and likely to admit patients who GPs would monitor.

However, they also found patients in more affluent areas benefitted more.

It states: ‘While there are significant drops in all attendances and cases of moderate severity in counts of patients from the less wealthy neighbourhoods (below median price), there are large and additional drops in patients from wealthier neighbourhoods.’

GPC deputy chair Dr Richard Vautrey warned that with practices under ‘incredible strain’ from rising patient demand and funding shortages, many were struggling to provide adequate access during the week.

He said: ‘This study needs to be taken alongside others which haven’t shown a significant reduction in hospital activity and it should also be noted that schemes such as this have only been possible through significant additional, short-term funding.

‘Many of the pilots have shown that appointments provided on a Sunday were not used by patients, wasting vital NHS resources. Current GP services badly need significant new funding to enable an immediate increase in staff to allow GPs to be able to meet the growing needs of their patients. This should be a priority before there can be any expansion in what practices already offer.’

Dr Vikram Pathania of Sussex’s School of Business, Management and Economics, who led the study, said: “There is clearly evidence of unmet demand for weekend GP opening.

’Seven-day opening for GPs appears to make a dent in two major sources of A&E expense – admissions and ambulance usage. The latter alone shows a significant drop of nearly 20% on weekends. Costs aside, there is also strong evidence that patient healthcare, in many cases, could be better delivered by a visit to a GP.’

J Health Econ, available online 17 June