Can increased primary care access reduce demand for emergency care? Evidence from England's 7-day GP opening

Abstract

Restricted access to primary care can lead to avoidable, excessive use of expensive emergency care. Since 2013, partly to alleviate overcrowding at the Accident & Emergency (A&E) units of hospitals, the UK has been piloting 7-day opening of General Practitioner (GP) practices to improve primary care access for patients. We evaluate the impact of these pilots on patient attendances at A&E. We estimate that 7-day GP opening has reduced A&E attendances by patients of pilot practices by 9.9% with most of the impact on weekends which see A&E attendances fall by 17.9%. The effect is non-monotonic in case severity with most of the fall occurring in cases of moderate severity. An additional finding is that there is 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 impact on A&E attendances appears to be bigger among wealthier patients. We present evidence in support of a causal interpretation of our results and discuss policy implications.

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

“…For example, a quasiexperimental study of interventions to improve access to general practice in Greater Manchester, England, estimated a 26% reduction in ‘minor’ A&E visits but a statistically insignificant reduction of 3% across all A&E visits 70. A similar analysis in London, England, estimated a 10% decrease in A&E visits in four practices that extended opening times, but it found no effect in 30 neighbouring practices whose patients could use the practices with longer opening hours 71. It is important to consider the magnitudes of associations in whole populations when assessing this research area.…”

Hours worked by general practitioners and waiting times for primary care

“…In several OECD countries, policymakers have focused on encouraging general practices to provide extended working hours in an attempt to improve access. For example, in the United Kingdom, the government launched 7‐day opening of GP practices in 2013 (Dolton & Pathania, ), and in Australia, the government provides financial incentives for GPs to offer additional after‐hours coverage to patients (Department of Human Services, ). However, evidence from stated preference studies suggests that financial incentives will have little impact on increasing the total hours worked by GPs (Broadway, Kalb, Li, & Scott, ; Kalb, Kuehnle, Scott, Cheng, & Jeon, ).…”

“…Consequently, waiting times are a key measure of access to health care (Siciliani & Hurst, ). Delays in receiving primary care result not only in the risk of deterioration of patients' health but also an increase in hospital or emergency department use (Bindman et al, ; Cowling et al, ; Dolton & Pathania, ).…”

Quantile regression for overdispersed count data: a hierarchical method

“…Predictors are a GP practice deprivation score, the Index of Multiple Deprivation or IMD (DCLG, 2015), and two measures of perceived access to care for each GP practice. Access to primary care has been shown to reduce emergency hospital attendances and admissions (Dolton and Pathania, 2016). The access indicators are from an annual survey of patent views regarding their primary care (the GP Patient Survey) and are proportions of patients 'very satisfied' or 'fairly satisfied' with their GP practice opening hours, and proportions of patients describing the overall experience of their GP surgery as fairly good or very good.…”