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Poor GP services do not lead to missed A&E targets

Demand on A&E keeps rising with no extra system capacity

Adrian O'Dowd

Thursday, 24 July 2014

Poor quality GP services that fail to meet patient expectations do not lead to more pressure on A&E departments to the extent that they miss waiting time targets, concludes a report published today.

The latest QualityWatch report* from health think tank The Nuffield Trust and the Health Foundation looked at A&E attendances in the English NHS and what factors were contributing to increased pressure on the system.

For the report analysis, the authors tracked data on 41 million A&E attendances from 2010 to 2013.

Overall, researchers found A&E departments were experiencing a combination of factors that were leading to an increase in waiting times and hospitals across the country increasingly failing to hit their A&E targets.

The average occupancy of England’s A&E units increased by around 8% between 2010-11 and 2012-13 and despite large increases in the number of people using A&E services overall, attendances at major A&E units had only increased in line with what would be expected from population growth.

There was no great surge in attendances, but sustained small increases in attendance over the period, said the authors, but without additional departments being built, this meant there were an increased number of patients per department.

The report says previous studies had shown that A&E demand was linked to the ability to access (and satisfaction with) GP services in that practices with poor access and low satisfaction scores in the GP patient survey were associated with increased A&E attendances.

The authors looked at data on the accessibility of GP practices taken from the GP Patient Survey covering the periods July to March in 2011-12 and 2012-13 mapped to A&E attendance using the GP practice code recorded in the HES (hospital episode statistics) data.

However, the report’s authors said they found no meaningful relationship between perceived quality of GP services and breaches of the four-hour target in A&E, so changes in these scores were unlikely to have influenced achievement of the target in 2012-13.

The number of people spending more than four hours in A&E increased by more than 123,000 between 2011-12 and 2012-13, the report analysis showed.

Although A&E departments see more older people than they did previously, this factor only accounted for around 11% of the observed decline in performance against the four-hour target.

Report author and Nuffield Trust senior research analyst Ian Blunt said: “This report shows that many of the external factors suggested to explain the decline in performance on the four-hour target since 2012 only had a small effect.

“We may have reached the limit of what we can deliver with our current A&E capacity. Without either new money to invest in A&E, or new ways to divert people to other parts of the NHS, rising waits may be inevitable.”

Dr Mark Porter, chair of BMA Council, said: “The continued failure to meet rising demand with necessary investment means the NHS is now starting to buckle.

“Our emergency departments are full, patients are waiting longer to be seen and front-line services are stretched to breaking point. GPs are being unfairly blamed for queues in emergency departments, but they too are under unprecedented pressure with many surgeries unable to cope with rising patient demand.”

* Ian Blunt. Focus on: A&E attendances – Why are patients waiting longer? QualityWatch. The Nuffield Trust, the Health Foundation. July 2014

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