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a and e signJune 22 2016

Demand on accident and emergency departments has potentially reduced by almost a tenth with access to GP services extended to seven days a week. There has been a greater reduction in demand of around a sixth at weekends, a study on pilot schemes has found.

Researchers have looked at what impact the pilot seven-day GP services has had on patients attending A&E. They estimate that A&E attendances have reduced “by 9.9% with most of the impact on weekends which see A&E attendances fall by 17.9%.” The effect is due to “most of the fall occurring in cases of moderate severity.” There was also “a 9.9% fall in weekend hospital admissions (from A&E) which is entirely driven by a fall in admissions of elderly patients.”

The study looked at figures from pilot seven-day opening schemes in central London. “The reductions were almost entirely driven by fewer elderly patients with moderate injuries or illnesses – not, as the Government expected, by minor cases being diverted away from A&E,” said the University of Sussex.

“The researchers believe this is because A&E doctors take fewer risks with elderly patients they don’t know and choose to admit them to a ward to be ‘on the safe side’, whereas GPs have an intimate knowledge of their patients’ medical history and can send the less serious cases home after treatment. Essentially, GPs make far more effective ‘gatekeepers’ to more expensive treatments.”

Other points noted by the study was that many of the minor cases in A&E were “so-called frequent flyers - people who visit A&E on multiple occasions. Very few of these people took up the option to visit a GP instead.”

The outcomes “suggests that a nationwide roll-out of seven-day opening would not only reduce pressure on stretched A&E services as a whole, but that the impact would be biggest among the most costly cases.”

Professor Peter Dolton and Dr Vikram Pathania of Sussex’s School of Business, Management and Economics co-led the study. Dr Pathania said: “There is clearly evidence of unmet demand for weekend GP opening. Seven-day opening for GPs appears to make a dent in two major sources of A&E expense – admissions and ambulance usage. The latter alone shows a significant drop of nearly 20 per cent on weekends.

“Costs aside, there is also strong evidence that patient healthcare, in many cases, could be better delivered by a visit to a GP. Patients may automatically equate the size and complexity of a large hospital-based A&E unit with higher quality care. But typically A&E doctors are junior to GPs, who are equivalent to hospital consultants in terms of their medical training and expertise. Plus GP treatment is based on direct past experience with the patient and access to their medical records.”

The University has suggested there could be significant savings implications for NHS budgets, as unplanned hospital admissions cost around 30 times as much as a GP visit. Costs for patient access to services have been averaged as:

• an A&E visit - £114
• an ambulance call-out - £220
• an unplanned hospital admission - £1,489
• a visit to the GP - £45

While the study findings are based on pilot schemes, the University acknowledges that the longer-term impacts are unknown, and the people may start to use A&E more if the departments have become less crowded. It also notes that demand can vary with demographics such as age and affluence, and that some practice have reduced or stopped weekend opening due to a lack of demand.

Professor Dolton commented: “These findings suggest the need for a careful rethink about the efficiency of redirecting patients to extended GP surgeries to lighten the load in A&E - although this would need to be accompanied by a redirection of NHS funding to Primary Care.”

Links:

University of Sussex announcement

P Dolton and V Pathania. ‘Can Increased Primary Care Access Reduce Demand for Emergency Care? Evidence from England's 7-Day GP Opening’. Journal of Health Economics. Published online June 15 2016

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