Access to general practice and visits to accident and emergency departments in England: cross-sectional analysis of a national patient survey

Abstract

BackgroundThe annual number of unplanned attendances at accident and emergency (A&E) departments in England increased by 11% (2.2 million attendances) between 2008–2009 and 2012–2013. A national review of urgent and emergency care has emphasised the role of access to primary care services in preventing A&E attendances.AimTo estimate the number of A&E attendances in England in 2012–2013 that were preceded by the attending patient being unable to obtain an appointment or a convenient appointment at their general practice.Design and settingCross-sectional analysis of a national survey of adults registered with a GP in England.MethodThe number of general practice consultations in England in 2012–2013 was estimated by extrapolating the linear trend of published data for 2000–2001 to 2008–2009. This parameter was multiplied by the ratio of attempts to obtain a general practice appointment that resulted in an A&E attendance to attempts that resulted in a general practice consultation estimated using the GP Patient Survey 2012–2013. A sensitivity analysis varied the number of consultations by ±12% and the ratio by ±25%.ResultsAn estimated 5.77 million (99.9% confidence interval = 5.49 to 6.05 million) A&E attendances were preceded by the attending patient being unable to obtain a general practice appointment or a convenient appointment, comprising 26.5% of unplanned A&E attendances in England in 2012–2013. The sensitivity analysis produced values between 17.5% and 37.2% of unplanned A&E attendances.ConclusionA large number of A&E attendances are likely to be preceded by unsuccessful attempts to obtain convenient general practice appointments in England each year.

Patient experience of general practice and use of emergency hospital services in England: regression analysis of national cross-sectional time series data

“…It is therefore uncertain whether current plans to improve patient experience of general practice will provide net cost savings to the NHS. Previous research suggests that many A&E visits in England currently occur after a patient is unable to get a suitable general practice appointment,36 but the extent to which this can be changed in the short term is another matter. General practices, A&E departments and hospitals are embedded in complex systems that may act to resist change and reinforce the status quo, while patient behaviour may change in unexpected ways 67…”

“…For example, patients with poor experiences overall or of making appointments in the past may be more likely to visit an A&E department instead. Many patients report visiting A&E departments after being unable to get suitable general practice appointments,36 which may be affected by opening hours 37. Moreover, patients with acute illnesses who do not have prompt access to general practice may deteriorate and be at greater risks of requiring unplanned hospital treatment.…”

Socioeconomic deprivation and accident and emergency attendances: cross-sectional analysis of general practices in England

“…6,14 Locallevel studies have found that the ability to see a preferred GP 15 and satisfaction at being able to speak to a GP by telephone 12 are predictors of A&E attendance rates, although Harris et al found that access to primary care did not explain variation in A&E rates. 7 General practice standards of care, as evidenced by the national Quality and Outcomes Framework (QOF) 16 score, do not appear to influence A&E attendance rates.…”

Access to diagnostic tests during GP out-of-hours care: A cross-sectional study of all GP out-of-hours services in the Netherlands

“…the UK. [12,13] One of the main reasons why patients with apparently less urgent conditions present to A&E departments is to see a doctor and have diagnostic tests done in the same place. [14] For example, it is known that the patients' belief that radiography is necessary, is an important factor for attending an A&E department instead of an out-of-hours primary care facility.…”