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Primary care and out-of-hours provision not to blame for A&E pressures, say NHS managers

NHS managers have debunked the ‘myths’ that primary care provision and access to out-of-hours services are the biggest causes of pressure on the A&E system.

A survey by the NHS Confederation of 125 NHS managers reveal that almost half believe that the rising numbers of frail older people with multiple long-term conditions is the main cause of A&E pressures. This was followed by difficulties in discharging patients to appropriate community settings, which was cited by more than a quarter of respondents as being the main factor.

The lack of organisational and system-wide emergency care planning was the next most relevant factor, only then followed by perceptions of changes to primary care provision and access to out-of-hours services.

This is despite health secretary Jeremy Hunt’s comments that the 2004 GP contract and its subsequent apparent changes to primary care access were the biggest factors for A&E pressures, which has seen emergency admissions increase by 51% in the past decade.

This comes after the Government announced it was to provide £500m funding to help the poorest performing A&E departments deal with A&E pressures this winter.

The NHS Confederation’s report, ‘Emergency care: an accident waiting to happen?’, sought to debunk the ‘myths and misinformation’ which ‘are hiding true state of NHS emergency services and risk undermining patient care’.

Its opinion poll asks respondents to rank six major sources of A&E pressures, as identified by NHS Confederation.

The lowest priority factor was NHS 111, the troubled helpline established in April.

The report concluded: ‘NHS leaders are clear – rising numbers of frail older people with long-term conditions are the most significant cause of growing pressures on urgent and emergency care.’

It added: ‘To tackle rising demand, we need more investment in primary and community care, a national campaign to explain the alternatives to A&E and wholesale reform of incentives in the NHS.’

Mike Farrar, chief executive of the NHS Confederation, said: ‘Clearly there isn’t one solution to the A&E problem. There needs to be cultural change in order to introduce seven day a week working in the NHS and social care, and a greater shift of our resources to enhance community services, so patients are treated closer to or in their homes rather than automatically default to A&E when they are ill.’