Hospital emergency departments bear brunt of change to GPs' out of hours contracts

New research by Warwick Medical School at the University of Warwick has found clear evidence to support the view that hospital emergency departments are facing increased demands which coincides with the changes to the GP contract  in 2004.  That change led to a number of GPs transferring out of hours care to Primary Care organisations.

The Warwick researchers Dr Joanne Fisher, and Professor Matthew Cooke, looked at patient numbers in two hospitals in the Heart of England NHS Foundation Trust (Heartlands Hospital in Birmingham and Solihull Hospital). They found the following changes since October 2004:

" Out of hours attendances at those hospital emergency departments had increased 27%

" There was a 9% increase in self referrals

" In particular attendances for less severe conditions - of the sort that might be suitable for care by a  GP  had increased  51%

" Over the same  period the number of attendances for major illnesses or trauma (the sort of illness or injury in which patients would usually always elect to go to an emergency department) hardly altered at all

" One of the biggest increases was seen in the number of parents bringing in children with respiratory conditions.  The most common problem seen by GPs in the out of hours period.

This pattern is not confined to the two hospitals studied. Increases in emergency department attendances are being reported across the country.  "Attendances increased by 13%" say the British Association for Emergency Medicine. This also not first time, this pattern has been seen research in the Netherlands in 2000 also showed increases in emergency department attendances after a similar change to out of hours care.

The Warwick researchers praise the Heart of England NHS Foundation Trust's response to this increased demand. At both Hospitals the Trust has established out of hours GP services located immediately alongside the Hospital's emergency departments allowing patients to be seen by the physician with the most appropriate skills for their condition. The Trust is trying two models. In the Birmingham Hospital the GP out of hours service is immediately alongside but clearly separate from the A&E service. In the case of Solihull the Trust has just opened a new GP out of hours service in the same area as the Hospital's A&E department and having a shared reception.. Patients are allocated to a GP or an A&E clinician according their need providing the patients with  a single seamless service with no need to be passed from one reception desk to another.

Professor Matthew Cooke, who works at both Warwick Medical School and Heart of England NHS Trust, said: "The new services at both sites are responding to the changes that are occurring in how patients seek emergency care. By working together, primary care and the emergency department can ensure that all patients are seen by the most appropriate clinician."

For further information please contact:
Professor Matthew Cooke, Warwick Medical School
Office: 024 76 573005

Or Dr Joanne Fisher  Warwick Medical School
Office: 024 76 572940

Peter Dunn, Press and Media Relations Manager, Communications Office, University House
University of Warwick, Coventry CV4 8UW 07756 655860
or email:

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