Extending primary care hours is linked to fewer A&E visits

An A&E sign at a hospital directs patients.

Adding evening and weekend hours to primary care practices is linked to fewer A&E visits for minor problems, a CLAHRC Greater Manchester article in PLOS Medicine shows.

Keeping primary care practices open for more hours on nights and weekends is linked to a 26.4% relative reduction in patient-initiated A&E visits for minor problems, according to the new study by The University of Manchester’s Dr William Whittaker and colleagues.

Most GP practices in the UK provide primary care services from 8:30am to 6:30pm, and patients who need care outside of these hours often turn to A&E; an estimated 26.5% of A&E visits in England follow unsuccessful attempts to access primary care. In an attempt to lower the costs associated with A&E visits, NHS England (Greater Manchester) provided £3.1 million to enable 56 primary care practices in the Greater Manchester area to provide additional evening and weekend urgent and routine appointments during 2014. Using routinely collected data from 2011 to 2014, Whittaker and colleagues compared the change in the number of A&E visits by the 346,024 patients of the extended-access practices to the 2,596,330 patients from 469 practices providing routine access.

While there were no differences in the total number of A&E visits, the researchers found that patients registered to the extended-access practices had a 26.4% relative reduction in patient-initiated A&E visits for minor problems compared with patients from practices providing routine access. Moreover, there was a 26.6% relative reduction in costs of minor A&E visits, saving £767,976. On the basis of A&E savings alone, extending primary care is unlikely to be cost-effective. For every three booked additional primary care appointment slots added to a practice’s schedule, one A&E visit was avoided, the researchers concluded. However, the study did not have enough data to perform a formal cost-effectiveness analysis, and no data were collected on patient health outcomes. As such the analysis does not take into consideration the potential benefits to those patients using additional appointments who would not have visited emergency departments otherwise.

Dr Whittaker says:

“Our study suggests that extending opening hours in primary care may be a useful addition to policies aiming to reduce pressures on hospital services, potentially reducing patient-initiated use of A&E for minor problems—but at a significant cost.”

The article is now freely available from PLOS Medicine.

For more information please contact Dr William Whittaker.