Healthcare use among preschool children attending GP-led urgent care centres: a descriptive, observational study

Abstract

ObjectiveUrgent care centres’ (UCCs) hours were developed with the aim of reducing inappropriate emergency department (ED) attendances in England. We aimed to examine the presenting complaint and outcomes of care in 2 general practitioner (GP)-led UCCs with extended opening times.DesignRetrospective observational epidemiological study using routinely collected data.Setting2 GP-led UCCs in London, colocated with a hospital ED.ParticipantsAll children aged under 5 years, attending 2 GP-led UCCs over a 3-year period.OutcomesOutcomes of care for the children including: primary diagnosis; registration status with a GP; destination following review within the UCC; and any medication prescribed. Comparison between GP-led UCC visit rates and routine general practices was also made.Results3% (n=7747/282 947) of all attenders at the GP-led UCCs were children aged under 5 years. The most common reason for attendance was a respiratory illness (27%), followed by infectious illness (17%). 18% (n=1428) were either upper respiratory tract infections or viral infections. The majority (91%) of children attending were registered with a GP, and over two-thirds of attendances were ‘out of hours’. Overall 79% were seen and discharged home. Preschool children were more likely to attend their GP (47.0 per 100) than a GP-led UCC (9.4 per 100; 95% CI 8.9 to 10.0).ConclusionsTwo-thirds of preschool children attending GP-led UCCs do so out of hours, despite the majority being registered with a GP. The case mix is comparable with those presenting to an ED setting, with the majority managed exclusively by the GPs in the UCC before discharge home. Further work is required to understand the benefits of a GP-led urgent system in influencing future use of services especially emergency care.

The impact of general practitioners working in or alongside emergency departments: a rapid realist review

“…General practitioners were also noted to over-ride nurse decisions to select patients that suited their own interests or perceived skills 42. Increased general practitioner streaming rates were reported when there was a good relationship between the general practitioners and emergency department nurses,40 and when the general practitioners were directly involved in the streaming process 43 44. The influence of commissioning or leadership was not described.…”

“…Several paediatric primary studies supported general practitioners treating children triaged as ‘non-urgent’ to divert attendances from the emergency department,43 53 and reduce hospital admissions 5 66. None of the included primary studies described general practitioners specifically treating care home residents or the elderly, as suggested in a policy document 28…”

Paediatric contacts with the UK out-of-hours primary care service and contact outcomes: a regional service evaluation

“…Amongst children under 5 the most common complaints to a UCC are respiratory system, infectious, or parasitic diseases [ 11 ]. In contrast, older children, especially those aged over 15 [ 11 ], use primary care services less, but present more commonly to UCCs with musculoskeletal complaints [ 12 ]. Our findings suggest that the profile of paediatric demand on OOH GP is more similar to that of the ED than the UCC.…”

“…This use peaks at 18:00 on weekdays, although not at weekends [10]. Amongst children under 5 the most common complaints to a UCC are respiratory system, infectious, or parasitic diseases [11]. In contrast, older children, especially those aged over 15 [11], use primary care services less, but present more commonly to UCCs with musculoskeletal complaints [12].…”

“…Understanding the nature and outcomes of contacts with NHS services is key to evaluating and improving these services. Paediatric contacts with NHS services have been described in relation to Emergency Departments (ED) or Urgent Care Centres (UCC) [10][11][12] . In OOH primary care services in eight European countries, up to a third of contacts were shown to be for children under the age of 18 [13] and a third of out of hours consultations amongst under 12 s were fever related in a Dutch OOH GP service [14].…”