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Emergency admissions reduce when older patients see ‘regular GP’, report finds

Patients registered with GP practices that offer more accessible care and those who see the same GP over time are less likely to be admitted to hospital, new research has suggested.

The report published by the Health Foundation found that around 14% of all emergency admissions were for conditions theoretically manageable in primary care, while more than a quarter of unplanned A&E attendees had previously been unable to get a ‘convenient’ GP appointment.

It said there is ‘significant potential for impact’ in this area, and that improving access to GPs and reversing the ‘trend of underfunding and understaffing’ could reduce admissions.

This comes after the National Audit Office told NHS England earlier this year that it must make ‘measurable’ reductions in emergency admissions by 2020, despite warnings that it could ‘create additional demand’ for general practices.

The Health Foundation looked at trends in emergency admissions over the past decade, and found that the number of patients admitted urgently to hospital had increased by 42% over that period, while the number with five or more health conditions rose from one in 10 to one in three.

Alongside this, the cost of emergency admissions increased from £5.5bn to £17bn between 2006/07 and 2016/17.

The new research examined data for patients aged between 65 and 85 years and found that those who saw the same GP over time were admitted to hospital less often than those who didn’t see the same GP as much.

It said that if older patients saw their most frequently seen GP two more times out of every 10 consultations, this would result in a 6% decrease in admissions.

The researchers also looked at the impact of extending opening hours and saw that patients registered to practices with extended access were 26.4% less likely to initiate A&E visits for minor complaints than patients at other practices.

Despite these reductions, this only equated to a 3.1% drop in A&E visits overall, and no information was available for admission rates.

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Additionally, the report estimated that 26.5% of all unplanned A&E attendances in England were preceded by the patient being ‘unable to obtain a GP appointment that was convenient to them’, although comparatively few of these resulted in an admission.

The paper said: ‘Research has shown that patients who are registered at general practices that offer more accessible care experience fewer emergency admissions, as do patients who tend to see the same GP over time.

‘There is significant potential for impact in this area, as around 14% of all emergency admissions are for conditions that are, at least in theory, manageable in primary care.

‘Policies are now in place to improve access to general practice and reverse the trend of underfunding and understaffing, but they will take time to bear fruit.’

Health Foundation chief executive Dr Jennifer Dixon said: ‘Some of the increase is because the NHS is able to keep older and sicker patients alive for longer, who then return to hospital. However, it could also suggest that health and care support in the community is not as good as it could be.’

Royal College of Emergency Medicine president Dr Taj Hassan added: ‘It is high time decision makers gave up on futile redirection schemes and planned for the demand we have rather than the demand that is hoped for.

‘We must ensure we have sufficient numbers of senior decision makers in emergency medicine and improve ambulatory care pathways, as well as access to appropriate services in the community, in order to effect safer discharge.’

Research published last year found that patients who see different GPs from visit to visit are more than twice as likely to be admitted to hospital.

The study looked at 10,000 patients aged over 65 from nearly 300 GP practices, and found that older patients who see the same or a small number of GPs are at a reduced risk of emergency hospital admissions compared with those who do not.

Researchers suggested that plans to enhance continuity of care could reduce hospital admissions.