The crisis in Accident and Emergency (A&E) departments, with many stretched to breaking point, would be much less serious if patients had better access to GPs, according to a new study to be presented at the Royal Economic Society''s 2015 annual conference. Peter Dolton and Vikram Pathania have examined the effect of weekend GP opening hours in four surgeries in London, and find that their patients reduced A&E visits by 8%.
The research analyses the effects of a pilot from the four surgeries funded under the £50 million Challenge Fund Initiative. Among the findings:
• An 8% fall in flow of cases to A&E from the surgeries'' patients.
• The reduction is largest on weekends. A least some of the patients who were previously deciding to go to A&E on weekends opted to go to their GP instead.
• There is also a smaller fall in A&E use on weekdays, perhaps due to it being easier to get a GP appointment.
• Only the non-urgent cases are diverted away from A&E. There is an 18% drop in the number of such cases showing up at A&E from the registered patients of the four pilot surgeries – and no change in the flow of urgent cases to A&E.
The authors also note that weekend GP opening has benefits for elderly patients who visit A&E at weekends. Cautious doctors are more likely to admit them to hospital, while GPs, familiar with their case histories, admitted 8% fewer of them.
The impact of this analysis has benefits to the NHS beyond solving the immediate overcrowding problems of A&E departments. The authors note that an A&E visit costs the NHS roughly £114, while a GP appointment costs about £25. They conclude:
''In a survey of GP patients conducted in 2014, among those who found GP opening hours inconvenient, 74% wanted surgeries to be open on Saturdays and 37% wanted them open on Sundays.
''Not all surgeries have to open every weekend: a cost-effective solution would be to rotate the weekend opening across surgeries.''
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Can increased access to GPs reduce overcrowding at A&E?
In many hospitals across the UK, Accident and Emergency (A&E) departments are being stretched to breaking point by heavy caseload. At the same time, there is growing concern about patients lacking ready access to their GPs. The two issues are intertwined: patients who are unable to get prompt GP appointments might be turning in desperation to A&E for medical care.
One possible solution to both problems is to extend GP surgery opening hours. Having GP surgeries open on weekends is a big step in this direction. In a survey of GP patients conducted in 2014, among those who found GP opening hours inconvenient, 74% wanted surgeries to be open on Saturdays and 37% wanted them open on Sundays.
Under the £50 million Challenge Fund Initiative launched in 2013, several surgeries are already piloting weekend opening. This study investigated whether patients registered at four such GP surgeries in London were less likely to use A&E services after those surgeries started opening on weekends as well.
Indeed, the researchers find an 8% fall in flow of cases to A&E from those patients. Unsurprisingly, this reduction is largest on weekends. A least some of the patients who were earlier deciding to go to A&E on weekends are now opting to go to their GP instead.
There is also a smaller fall in A&E use on weekdays. It could be that the extra hours on the weekend take some of the pressure off the surgery on weekdays, making it easier to get a GP appointment, which in turn has a knock-on effect of reducing the number of patients turning to A&E for care.
It is only the non-urgent cases that are being diverted away from A&E to the GPs. There is an 18% drop in the number of such cases showing up at A&E from the registered patients of the four pilot surgeries. There is no change in the flow of urgent cases to A&E, which is reassuring. One would expect such cases to go directly to A&E or if they did show up at the surgery, to be referred immediately to A&E.
Being able to see their GP can be especially important for elderly patients. If elderly patients have to be turn to A&E instead, the medical staff there will typically err on the side of caution and admit them. GPs, on the other hand, are familiar with the case history and medical records of elderly patients, and would have more accurately assessed whether hospital admission is indeed warranted. Weekend surgery opening appears to benefit elderly patients: there is an 8% drop in the number who are admitted to hospital after an A&E visit.
Opening surgeries on weekends clearly shows promise in decongesting overloaded A&E departments. In addition, there could be significant cost savings. An A&E visit is much more expensive than a GP visit: the former costs roughly £114 while the latter costs about £25. Not all surgeries have to open every weekend: a cost-effective solution would be to rotate the weekend opening across surgeries.
