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Strain on primary care services 'driving pressure on A&E'

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Strained accidedent and emergency departments are having to deal with millions of additional patients because people are struggling to get a timely GP appointment, new research suggests.

Estimates suggest that nearly six million attendances at English A&E departments could be due to patients being unable to get a convenient appointment with their family doctor, the study found.

For every 100 patients who try to get an appointment at their local GP surgery, 1.7 will resort to attending the emergency department, the authors said.

“There needs to be long-term, sustained investment in GP services, including an expansion in the number of GPs, nurses and other healthcare professionals working in the community”

Richard Vautrey

Experts from Imperial College London analysed the results from the national GP Patient Survey from 2012-13, which is answered by around one million patients, and the annual numbers of GP consultations.

The research, which has been published in the British Journal of General Practice, found that while the majority of patients said they could get a convenient appointment, 1.67% of those who attempted to get an appointment visited A&E after not being able to get a timely consultation, the authors said.

They estimated that for 2012-13 this figure would equate to 5.77 million A&E visits − or 26.5% of unplanned attendances during this time frame.

Lead researcher, Thomas Cowling, a doctoral research fellow at Imperial College London, said: “There has been a lot of talk in recent years about rising numbers of A&E attendances and the impact that this might be having on A&E departments.

Imperial College

Thomas Cowling

“It has been suggested that a lack of access to GPs could be a factor but there hasn’t been much evidence to back this up.

“Our research has provided a helpful indication of the situation, but we acknowledge the uncertainty present in the estimates.”

The British Medical Association (BMA) recently warned that two-week waits for routine appointments with family doctors could soon become commonplace.

Commenting on the latest research, Dr Richard Vautrey, deputy chair of the BMA’s GP committee, said: “General practice is under intense pressure from a combination of rising patient demand, especially from an ageing population, and funding cuts.

“There are not enough GPs and other staff available to treat the sheer number of people coming through the surgery door. However, given the unsustainable strain on GP services, it is understandable that patients are becoming frustrated at the number of appointments available, something that GPs are just as concerned about.

“We need politicians to realise that there needs to be long-term, sustained investment in GP services, including an expansion in the number of GPs, nurses and other healthcare professionals working in the community. This is not a problem that is going away, we need urgent action.”

But the College of Emergency Medicine questioned the findings.

Its president Dr Clifford Mann, said: “In our experience most patients we see have made the right call in coming to A&E.

“We recently conducted our own research and found that 15% of patients who attended could be safely redirected to their GP. This is less than the number estimated in the research by Imperial College but still represents 2.1 million patients per year.


Clifford Mann

“It is therefore unarguable that a significant number of patients could be seen elsewhere if that capacity existed. In our opinion we see the co-location of GPs with emergency departments as a significant part of the answer to the challenges of dealing with the annual increases in A&E attendances.”

The most recent figures from NHS England show that around 450,000 people attend A&E every week.

Ben Dyson, director of commissioning policy and primary care at NHS England, said: “Since 2002-03, the money that the NHS spends on GP services has increased by a third and patient consultations have been increasing year-on-year, but patients should not be unable to get appointments.

“A major programme of work to help transform GP services, including patient access, has begun, including the prime minister’s £50m Challenge Fund that will support GPs in improving access to services, in more modern ways with greater use of telephone, email and video consultations as well as more flexible appointment times.”


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