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Extended GP opening hours are unlikely to ease burden on A&E

Study finds patient satisfaction with GP opening hours had little impact on their likelihood of visiting A&E

Ingrid Torjesen

Monday, 22 January 2018

There is little association between patient satisfaction with GP opening hours and the number of visits they make to A&E, a study* published in BMJ Quality & Safety has found, but where patients are happier with the ease of making appointments, such as having the ability to book online, there were slightly fewer.

Researchers at Imperial College London compared patients' experiences of GP surgeries with the number of A&E visits in their areas in England from 2011-2012 to 2013-2014 using data from NHS England's annual GP Patient Survey.

They accessed data on levels of patient satisfaction in terms of ease of making an appointment, opening hours, and overall experience and matched that data with figures on use of local A&E departments.

Mean practice-level rates of A&E visits and emergency admissions increased from 2011–2012 to 2013–2014 (310.3–324.4 and 98.8–102.9 per 1000 patients). Each patient experience measure decreased; for example, mean satisfaction with opening hours was 79.4 in 2011–2012 and 76.6 in 2013–2014.

Overall, the results showed that areas where patients were happier with the ease of making appointments, which could be for example by using online booking systems, saw slightly fewer visits to A&E. However, satisfaction with surgery opening hours and overall patient experience seemed to have no impact on A&E visit rates.

The study suggests that better satisfaction with GP hours, for example because of extended opening hours, does not affect the number of visits made to A&E in their geographical area. However, making the appointment booking process easier for patients was associated with slightly fewer A&E visits in that area.

The authors say their research supports finding alternative options for easing the burden on A&E departments, and might call into doubt the Government's proposals to extend GP surgery hours to ease the burden on A&E departments.

The authors measured satisfaction with hours without linking explicitly them to daytime, weekday or evening and weekend appointment availability. They hypothesise that although weekend and evening appointments are convenient for healthy, working-age adults, those who are likely to need medical attention more urgently are older people or those who are chronically ill and not currently working full-time.

Senior author Professor Azeem Majeed from Imperial's School of Public health, who is a practising GP, said: "The government must find alternative ways to handle current pressures on A&E departments. This could include for example improving access to GP appointments during normal opening hours rather than spending scarce NHS resources on extended opening schemes."

Dr Cowling, also from Imperial's School of Public Health, said: "It makes sense to think that extending GP hours will ease the burden on other NHS services, but our study suggests this might not be the case with A&E."

*Cowling T, Majeed A, Harris M. Patient experience of general practice and use of emergency hospital services in England: regression analysis of national cross-sectional time series data. BMJ Qual Saf 2018;0:1–12. doi:10.1136/bmjqs-2017-007174 1

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