GP access not to blame for rising pressure on A&E, researchers find

GPs are being incorrectly used as scapegoats to explain away rising rates of A&E attendances, according to researchers who found that long-term conditions and deprivation are the likely root cause.

Waiting room (Photo: Simon Barber)
Waiting room (Photo: Simon Barber)

Long-term health conditions and deprivation, not lack of GP services, are the main contributors to rising A&E attendance rates, according to research published in the British Journal of General Practice (BJGP).

Researchers from Queen Mary University of London found that having multiple long-term conditions was the ‘strongest predictor’ of emergency department attendance.

Looking at anonymised data on GP and A&E attendance for over 800,000 east London patients, they found that patients with more A&E attendances also have higher GP consultation rates.

The results therefore run contrary to the popular idea that the steady rise in A&E visits is due to patients having poor access to primary care, they concluded.

GP access

Instead, the results showed that patients with four or more long-term health conditions attended A&E six times more than those who had none.

The researchers also found a link between deprivation and the frequency of A&E attendance.

Patients in the most deprived groups had attendance rates 52% higher than those in the least deprived, the findings showed.

These two key pressures combine and exacerbate one another, they added. Further findings showed patients in the most deprived group who had four or more long-term conditions and also smoked had an emergency attendance rate three times higher than the same type of person in the least deprived areas.

A&E attendances

Rates of emergency department attendance have more than tripled over the past 50 years, reaching 373 per 1,000 population in 2015/16.

In contrast to some other studies, the researchers found that patient experience of GP access, as reported to their practice, did not predict use of A&E services.

Lead researcher Dr Sally Hull said: ‘The pressures on emergency departments, especially during winter, are enormous.

‘When departments are very busy, with long waits and difficulties finding beds for people needing admission, it is easy to seek scapegoats and suggest that poorly functioning GP services are to blame for the crisis.

‘Our research shows that this is not the case. The same people who attend their GP surgery a lot also attend their emergency department a lot.

Workload pressures

'This is largely because they have multiple long term health conditions, both mental and physical, and it is these conditions, along with an ageing population, which are driving the high attendance rates.'

RCGP chair Professor Helen Stokes-Lampard said: ‘General practice makes the vast majority of patient contacts in the NHS and by doing so we alleviate pressures on emergency departments, we don’t add to them – this research backs this up with important new data.

‘UK general practice is currently facing intense resource and workforce pressures. Our workload has risen at least 16% over the past seven years, but the share of the overall NHS budget we receive is less than it was a decade ago, and the number of GPs has not risen at pace with demand.

‘We urgently need NHS England’s GP Forward View, pledging £2.4bn extra a year and 5,000 more GPs, to be delivered in full, so that we continue to deliver the most cost-effective service in the NHS, and deliver the changing care our patients need and deserve.’

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