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Chronic conditions driving A&E visits 'not lack of primary care'

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Rising accident and emergency attendance rates are being driven by long-term health conditions, rather than a perceived lack of GP provision, according to East London researchers.

Rates of A&E attendance have more than tripled over the past 50 years, from 105 per 1,000 population in 1961 to 373 per 1,000 in 2015-6, noted the study authors from Queen Mary University.

Their study, published in the British Journal of General Practice, also comes at a time when the NHS is facing unprecedented winter pressures, with all parts of the system experiencing capacity issues.

They highlighted that previous studies had identified socio-economic deprivation as a major driver for A&E attendance, but that such studies were based on GP practice level and population data.

For the first time, they said they had looked at anonymised data from individual patients, and linked separate GP and A&E records to get a more accurate picture of attendances over a two-year period.

“The same people who attend their GP surgery a lot also attend their emergency department a lot”

Sally Hull

The researchers analysed data from 819,590 GP registered patients in 136 practices falling under the clinical commissioning groups of Newham, Tower Hamlets and City and Hackney.

They found having multiple long-term health conditions was the strongest predictor of emergency department attendance. This along with social deprivation were the major drivers of A&E use.

There was a six-fold increase in A&E attendance rates in those with four or more long term health conditions, compared to those with no such conditions, said the researchers.

In addition, smokers lin the most deprived areas with four or more long-term conditions attended A&E around three times more often than the same type of person living in the least deprived areas.

Attendance rates for the most deprived population group were found to be 52% higher than those for the least deprived – 366 per 1,000 of the population versus 240 per 1,000, respectively.

“It is easy to seek scapegoats and suggest that poorly functioning GP services are to blame for the crisis”

Sally Hull

Patients with more A&E attendances also had higher general practice consultation rates, noted the researchers, suggesting rises in A&E attendance were not explained by poor access to primary care.

Patient experience of primary care access, reported at practice level, did not predict their use of emergency departments, unlike findings from previous studies, noted the study authors.

Lead researcher Dr Sally Hull said: “The pressures on emergency departments, especially during winter, are enormous. It is easy to seek scapegoats and suggest that poorly functioning GP services are to blame for the crisis.

“Contrary to the popular narrative that people are using emergency departments rather than their GP surgery, our research shows that this is not the case,” she said. “The same people who attend their GP surgery a lot also attend their emergency department a lot.

“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,” said Dr Hull. “These effects are exacerbated by socio-economic deprivation.”

“We need better messaging for the public as to the different medical services available to them”

Helen Stokes-Lampard

Dr Hull highlighted that, in recent years, there had been a growing trend towards the idea that emergency department units could be reduced and replaced with community-based support.

“This would require investment in both social care and community health services, and close alignment with the perceived needs of patients seeking urgent care,” she warned.

“It is crucial that we carry out studies like this to understand why people attend emergency departments, and to identify the services which can be safely taken over by GP and community services,” she added.

The study authors said that, as the study was set in East London, it was relevant to other inner urban areas with similar levels of material deprivation and ethnic minority populations.

But they also cautioned that, as a result of this fact, their findings may not be representative of the country as a whole.

helen stokes lampard blog image

helen stokes lampard blog image

Helen Stokes-Lampard

Professor Helen Stokes-Lampard, chair of the Royal College of GPs, said primary care teams were “working incredibly hard” to deliver more consultations than ever across the UK.

She 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.”

She added: “It is also clear from this research that we need better messaging for the public as to the different medical services available to them, within routine working hours and out, so that our patients know the most appropriate place to turn when they become sick.”

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Readers' comments (1)

  • Whilst I understand that people with chronic conditions are likely to attend A&E more often, and attend GP surgeries more often, I still believe that difficulty with obtaining GP appointments is responsible for many A&E visits. How many researchers have tried to get a GP appointment urgently? Start ringing from the crack of dawn and continue to try until you manage to get into a queue. Then you wait sometimes an hour to actually be number 1 and talk to a receptionist. Of course if you are feeling absolutely awful you would not want to do all that, and anyway when you finally get through there may be no appointments left. You will then have to try to persuade the receptionist that you cannot wait for another day, and most people, especially the elderly feel embarrassed about doing that. So they ask for an 'ordinary' appointment. "Yes of course, that will be Friday week, yes that is right in 12 days time"!!!!

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