In the largest analysis of its kind to date, researchers at Imperial College London related A&E attendance figures in England to responses from a national survey of patients’ experience of GP practices in 2010-11. One question of this survey asked patients whether they had been able to see a GP within two weekdays when they had last tried.
GP practices whose patients reported more timely access to appointments had lower rates of A&E visits in which the patient referred themselves and was discharged.
With A&E units across England straining under rising demand for urgent and emergency care, many have called for better access to GPs as a way to lower A&E attendances. However, there is no previous evidence to suggest this strategy could be effective at a national level.
According to the analysis, the rate of A&E visits for the fifth of practices with the best access was 10.2 per cent lower than the fifth of practices with the worst access. If the bottom fifth had performed as well as the top fifth, the researchers estimate this would have resulted in 111,739 fewer A&E visits for the year.
The findings are published in the open access journal PLOS ONE.
Lead author Thomas Cowling, from the School of Public Health at Imperial College London, said: “This is the first national evidence of an association between access to GP appointments and rates of A&E attendances in England. Policymakers should consider this relationship when designing plans to reduce the use of A&E departments.
“A new era of service commissioning, led by GPs, has just started in the NHS. It will be interesting to see what effect, if any, this has on access to GP appointments and, in turn, on A&E visits.
“Increasing demand for urgent and emergency care is a major issue in many developed countries, in addition to England. In the United States, the situation is more complex as some patients experience financial barriers to accessing primary care. This is increasingly also the case in some European countries as a result of economic austerity.”
1. T.E. Cowling et al. ‘Access to Primary Care and Visits to Emergency Departments in England: A Cross-Sectional, Population-Based Study’ PLOS ONE (2013) http://dx.plos.org/10.1371/journal.pone.0066699
Imperial College London