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Better access to primary care curbs emergency care visits

Study puts GPs back in the frame for A&E pressures

Caroline White

Thursday, 13 June 2013

Better access to primary care services helps curb the number of people pitching up to emergency care, finds research published online in PloS One.

The findings are likely to put GPs back in the frame as contributing to the unsustainable pressures faced by emergency care departments in England and reignite the ongoing dispute as to who is to blame.

The number of visits to hospital emergency departments in England has risen 20% since 2007-08, amid concerns that some patients are pitching up for emergency care because they are unable to access primary care services when they need them.

The Imperial College researchers carried out a cross-sectional, population-based analysis of patients registered with 7856 general practices in England in a bid to see if there was any link between self-referrals to emergency care and primary care access.

They therefore looked at self-referred discharge emergency care visits between April 2010 and March 2011 by the registered population of a general practice, focusing on those visits by patients whom a GP could have potentially managed or, at least, seen before the visit.

After taking account of population characteristics, supply of GPs, and travel times to health services, they found that those practices providing more timely access to primary care had fewer self-referred discharged visits per registered patient (for the most accessible quintile of practices, RR = 0.898; P<0.001).

They conclude that policy makers should consider improving timely access to primary care when developing plans to cut the use of emergency care.

Commenting on the findings, Dr Clare Gerada, Chair of the RCGP, said: “GPs currently provide 90% of NHS care with just 9% of the budget but our workload is ballooning and our patients are presenting with ever more complex and multiple conditions.”

The findings served to reinforce the College’s call “for major and urgent investment in general practice,” to cope with the additional workload she said.

“We are trying our best with very limited resources and we hope that the Imperial College London study will strengthen our case to inject more funding into general practice so that we can deliver the care our patients need and deserve, wherever they live,” she said.

But access to primary care services was not the only reason for the increasing pressure on emergency care, she said.

“Deprivation is identified as being much more significant, as is living in an inner city area, than GP access in explaining [ED] attendance, and this is very understandable,” she explained.

And she added: “We are only too well aware that access to GP services needs to improve in some areas- the paradox is that the more deprived an area, the fewer resources GPs in that area have. So, it is not surprising that patients in deprived and inner city areas attend emergency departments, but this report cannot become another excuse to unfairly blame us for pressures in the NHS.”

Access to Primary Care and Visits to Emergency Departments in England: A Cross-Sectional, Population-Based Study. PLoS ONE 8(6): e66699. Doi:10.1371/journal.pone.0066699

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