The relationship between GP access and reducing attendances in urgent care settings

Recently, a large study by the University of Sussex discovered that seven day GP opening reduced accident and emergency (A&E) attendances by 10 per cent during the week and up to 18 per cent at weekends. This was a study covering 34 practices in central London.

However, evidence from some pilots in the Prime Minister’s Challenge Fund (PMCF), suggested that lower than expected demand for appointments at weekends – particularly on Sundays – meant that A&E attendances were largely unaffected. We also found this to be the case.

We’ve analysed our own data for A&E, urgent care centres (UCC) and out of hours (OoH) attendances over a five month period at one of the practices we provide support to. We looked at attendance rates to these emergency/urgent services over the timeframe Practice Assist implemented telephone consultations and increased the core and extended hours capacity. We then compared the results with the year before.

The results were unequivocal. Local attendances fell by:
• 42 per cent in A&E
• 33 per cent in OoH
• 28 per cent in UCC

The practice’s GP partners were not aware of any other factors outside of the pilot (e.g. the practice maintained a stable patient list size) that could have led to these reductions in patients using emergency/urgent services. (A baseline comparison of North West London OoH activity for same period only shows a 6 per cent activity fall.)

It’s not rocket science. We have long known the highest pressure on primary care is usually in routine core hours of general practice. By extending the clinical capacity during this time and into the evenings we have demonstrated a very positive effect on decreasing A&E, UCC and OoH attendances.

It’s evidence of a system under pressure as patients are simply trying to find access to healthcare when they need it.

What does this mean?

It is clear that there needs to be an increase in capacity for in-hours and extended hours primary care to help divert patients away from A&E for certain healthcare problems.

New, innovative solutions such as Practice Assist, online web tools and support to increase clinical resource (such as developing homeworking capability for GPs) are needed. These are all examples of new ways of working that can help fix the ever increasing demand and supply issue.

Funding structures are also needed to support the development of these innovative solutions. Funding needs to bridge the adversarial gap between secondary care and primary care, but the key will be to increase capacity in primary care and not direct resources intended for those services towards A&E, where some patients simply don’t belong.

Dr Reggie Sangha. MRCGP
Medical Director - Practice Assist