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Surge in non-elective hospital activity hits CCG budgets          



CCGs are facing added financial pressures because of an unexpected rise in emergency admissions and a further rise in A&E attendances, a Pulse analysis of Hospital Episode Statistics data for England suggests.

The analysis, which compared the latest HES data with previous reports, reveals that between April and July this year A&E attendances increased by 5% and emergency admissions (including admissions via A&E) by 3.7% compared with the same period in the previous year.

This reversed the previous trend of decreasing emergency admissions. Between April and July 2010 and the same period in 2011, there was a slight fall in emergency admissions from 1,750,681 to 1,723,399. However, this increased to 1,786,341 between April and July this year.

A&E attendances continued their increase from 29.2m in April-July 2010 to 29.4m in April-July 2011 and 30.9m in April-July 2012.

The figures will come as a blow to the Department of Health, which in 2010 set GPs a target of cutting A&E attendances by 10% by the end of 2013, as well as a cut in unscheduled hospital admissions of 20%. At the time the DH’s clinical lead for quality and productivity, Sir John Oldham, warned there was ‘no plan B’.

Dr Michael Dixon, president of NHS Clinical Commissioners, said the figures were ‘disappointing’. He said CCGs `would be worried about financial pressures’ posed by emergency admissions, although they would not have to meet the full costs if these admissions rose beyond a certain point.

He said: `You can only keep people at home who would otherwise need referral if you have got good community resources. To date there are insufficient resources in the community, particularly if patients are frail and elderly or have complex conditions.’

He said there were places where unscheduled admissions were being avoided successfully but that support for patients ‘costs money, takes time and needs considerable will to set up’. Once it was set up, care could be `cheaper and better’, he said.

Dr Agnelo Fernandez, urgent and emergency care lead for the RCGP and joint chair of Croydon CCG, said emergency admissions were going up `everywhere’ and CCGs needed to explore the reasons behind the rise, although he cautioned that ‘GPs are not likely to be a factor in rising admissions’.

However, he added that primary care could have an influence on A&E attendances so the conversion rate of A&E attendances to admissions should be studied to identify `how much is patient factors and how much is the behavioural factors of clinicians’.

Dr Beth McCarron-Nash, a former GPC negotiator and a GP in St Columb Major in Cornwall, said the rise in emergency admissions should not be seen as a reflection on the new quality and productivity indicators introduced in the QOF.

‘It’s unfair to say the rise means the QP indicators have failed because we never thought that they would make a huge difference,’ she said. ‘The QP indicators were about looking hard at the data, understanding the patters and making a plan to try and make services better for patients. They weren’t about outcomes.’

A DH spokesperson said: `Eighty percent of in-patients are now in and out of hospital on the same day and the NHS is meeting the challenge of rising demand for services, but it is important that we remain focussed on delivering a good service for patients. Where clinically appropriate, it is better for patients to be treated or continue their treatment at home or in their community rather than in hospital.’