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NHS WALK-IN CENTRES DO LITTLE TO EASE PRESSURE ON A&E

Although walk-in NHS centres are popular, they are an expensive way and largely ineffective of taking the pressure off busy casualty departments. That is the central finding of research by Ted Pinchbeck, to be presented at the Royal Economic Society''s annual conference in Brighton in March 2016.

Walk-in health centres were used by the NHS in around 200 communities back in 2010, but around a fifth of them have closed since then. Offering extended hours and no need to book or register, they are often popular within their own communities. But until recently, there was little real evidence to tell whether or not they offer value for money.

The study looks at hospital and health centre records and finds that although walk-in centres do divert people away from A&E wards, only around 5-20% of the patients who visited them would have otherwise gone to A&E.

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In 2010 NHS Walk-in Centres were a valued feature of around 200 communities, but many centres in England have since closed or are facing closure. Research by Ted Pinchbeck at the ESRC Spatial Economics Research Centre to be presented at the Royal Economic Society conference may go some way to explaining why: less than a fifth of patients attending a centre would otherwise have attended an A&E, which indicates that the centres do little to relieve pressure at busy casualty departments.

Walk-in health services of one form or another feature in many healthcare systems, including Canada and the United States, and became prominent in England in the mid-2000s. But during the last parliament, around a fifth of all NHS walk-in centres shut their doors, with a number of other centres – for example in Redruth, Hereford and on Teeside – also at risk.

Why the services should close is not immediately clear: offering extended hours and no requirement for patients to pre-book or register, many had proved highly popular. The scale of local opposition to some closures – for example in Jarrow, Worcester and Southampton – was intense. Their supporters argue that they reach new groups of patients, provide easy access to care and take the pressure off other stretched services.

At the same time, commissioners closing centres argue that they represent a poor use of funds as many attendees have minor conditions that little need for medical attention, and those that do could readily be treated elsewhere. Some have cited the need to fund seven day a week access to GP services as a more pressing priority.

Until recently there was little hard evidence – from either side of the Atlantic – to inform these debates. The new evidence goes some way to filling this gap. Combining detailed information contained in hospital records with difference-in-difference techniques, the research provides credible estimates of how patients'' use of A&E departments changes in response to the opening of a new centre close-by.

Two main findings emerge. The first is that walk-in centres do significantly divert patients away from attending A&E. The second, however, is that relative to the number of patients attending walk-in clinics, the effect is small, with calculations suggesting only around 5-20% of patients attending a walk-in clinic would otherwise have gone to casualty. The implication is that they only make a small dent on the overall A&E figures.

The research points to something of a dilemma for decision-makers. Easy access services such as walk-in centres are popular, which suggests that they are valued by patients. The evidence suggests they do make a small contribution to relieving pressure at over-stretched emergency services, but with low diversion rates from A&E they may be an expensive way to do so.

The cold reality of a chilly funding climate points to hard choices in allocating scarce NHS resources to best meet local demand. With this in mind, fights over the remaining centres look set to continue.