Larger GP practices reduce emergency attendances, says spending watchdog

Patients of larger GP practices are less likely to attend A&E, according to a study by financial watchdog the National Audit Office (NAO).

Research by the NAO published on Friday found a 4% reduction in emergency department attendances for every additional GP in a practice.

The government spending watchdog also found a 3% reduction in attendances for every 1% increase in in the share of funding commissioners spent on community health services.

In 2013 NHS England’s review of urgent and emergency care suggested quality and access to out-of-hours services are strongly associated with A&E attendances.

While the most important factor affecting variation in emergency attendance was the characteristics of the underlying population, the NAO study found a complex relationship between awareness of GP out-of-hours services and A&E use, suggesting awareness of and satisfaction with services may not reduce demand in A&E.

GP out-of-hours care

Areas ‘with better patient awareness of out-of-hours GP care have a lower rate of attendance at A&E during out-of-hours – a 1% increase in out-of-hours care awareness is associated with a 2% reduction in the rate of out-of-hours A&E attendance’, the report said.

However, it added that ‘awareness is not associated with the level of overall attendance at A&E; this may suggest that some of the avoided out-of-hours A&E attendance is being delayed rather than avoided’.

The researchers said they found no association between perceived quality of out-of-hours services and attendance rates overall and during out-of-hours. But satisfaction with overall GP services is ’slightly associated’ with A&E attendance.

‘Patients registered with larger GP practices are less likely to attend A&E – on average, for every extra GP in a GP practice, there is a 4% reduction in the rate of A&E attendance,' researchers said.

The study follows an NAO report published in August 2014 which called on CCGs to step up assurance of GP out-of-hours services because of NHS England’s ‘limited oversight’.

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