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Merging practices into larger centres could increase A&E visits, finds study



Patients living closer to an A&E department are more likely to choose it over their local GP practice, according to a survey of the social influences driving people in deprived areas to A&E.

Researchers from the University of Liverpool conducted the survey in 20 disadvantaged neighbourhoods across the North West to understand why people go to A&E.

They found access to GP practices is ‘a unique determinant of A&E attendance’, and suggested consolidating practices into fewer and larger centres could therefore increase the number of visits to A&E.

The researchers collected the views of 3,510 residents across Lancashire, Cheshire and Merseyside, who provided information about their ‘physical health, mental health, lifestyle, social issues, housing, environment, finances and local health service usage’.

The paper, published in BMJ Open, said: ‘Living further from an A&E department reduced the likelihood of attending an A&E service by 7% per kilometre, and living further from a GP increased the likelihood of attending A&E by 46% per kilometre.’

‘The results indicate that primary care access predicts A&E attendance over and above the effects of health status, socioeconomic status and A&E access,’ it said.

Improving public transport links and locating practises in areas with high A&E attendance could bring rates down, the researchers suggested.

While they found living further from a GP practice encouraged more trips to A&E, the researchers also pointed to other contributing factors.

They noted that age was a factor, with 18-26 year olds being three times more likely to visit A&E, compared to those aged 64 and over.

Unemployment, depression, and a need for help with personal care were other factors that were highlighted.

Study co-author and research manager at the University of Liverpool Dr Clarissa Giebel said: ‘This is one of the first surveys to explore a comprehensive set of socio-economic factors, as well as proximity to both GP and A&E services, as predictors of A&E attendance in disadvantaged areas.

‘Inequalities around employment and housing are an important part of understanding the motivations for attendance levels and there is a clear need for closer consideration of the placement of primary care services and ensuring clearer public access routes to them.’

Earlier this month, researchers warned there is little evidence to suggest larger GP practice list sizes boost clinical outcomes or save money.

In a paper published in the journal Health Policy, researchers found trade-offs and unintended consequences mean the expected benefits from scaling up GP practices are hard to see on the ground.

They recommended NHS England take caution in rolling out such plans and pay close attention to unintended consequences.

A version of this story was first published on Pulse’s sister publication Healthcare Leader.

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