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Scant proof to support co-locating primary care services in A&E

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There is little evidence to back locating primary care services in emergency or urgent care facilities in a bid to curb patient demand and improve throughput, according to researchers.

The set-up costs dwarf the marginal savings to be made, they suggested following a review of the available evidence.

“This is likely to lead to confusion, longer pathways and lower degrees of satisfaction”

Study authors

Hospital trusts have begun co-locating GPs and practice nurses in accident and emergency departments, prompted by the theory that many attendees have problems that could be more appropriately dealt with in primary care.

The Sheffield-based researchers reviewed 20 relevant studies on unscheduled care given by primary care clinicians in, or immediately adjacent to, a hospital A&E, which were all published between 1980 and 2015.

The team assessed the impact on demand and throughput, patient satisfaction and cost effectiveness.

Their review found some evidence for an improvement in A&E waiting times, but it was not universal, and was likely to be simply due to the increased number of clinicians, said the researchers.

Overall, the review found little evidence of an improvement in crowding or throughput from streaming primary care patients out of emergency care.

“Not considering the consumer’s view is a recipe for disaster”

Derek Burke

Nor did it find that diverting emergency care patients to primary care services saved money, because set-up and ongoing indirect costs dwarfed the marginal savings to be made.

Neither patients nor staff particularly favoured a co-located service, added the study authors, who said that if anything it risked increasing workforce dissatisfaction.

The researchers said: “By blurring the line between emergency and primary care by co-locating services, there is a risk of losing the continuity of care that primary care provides, and encouraging ad hoc health seeking behaviour.”

“This is likely to lead to confusion, longer pathways and lower degrees of satisfaction with the services being used,” they said in the Emergency Medicine Journal.

Sheffield Children’s Hospital NHS Foundation Trust

Little evidence backs locating primary care in A&E

Derek Burke

They suggested patients were generally quite good at deciding where to access care and that inappropriate choices were largely the result of socioeconomic factors and shortcomings in the unscheduled care system.

In an editorial in the same journal, Professor Derek Burke, an emergency care consultant at Sheffield Children’s Hospital NHS Foundation Trust, said: “We must come to accept that unscheduled care is now a consumer item and seen by users as being no different from the availability of 24 hour shopping.

“In this age of consumer based healthcare provision, not considering the consumer’s view is a recipe for disaster,” he said.

 

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