Are patients going to A&E instead of GPs?

“This government are committed to maintaining and delivering that vital four-hour commitment to patients, but since it was announced in 2000, there are nearly 9 million more visits to our A&Es, up to 30% of which NHS England estimates do not need to be made, and the tide is continuing to rise.”

Jeremy Hunt, 9 January 2017

It's correct that there have been nine million more A&E visits since 2000/01. But the research finding that up to 30% of emergency cases were of a kind that GPs regularly deal with doesn’t apply to all A&Es.

The research is specific to major A&E departments. They deal with about two thirds of all A&E cases. 

30% is also the higher end of the estimate. The researchers found it was somewhere between 10% and 30%.

Increasing numbers in A&E?

The number of yearly visits to A&E departments of all kinds increased by 9 million between 2000/01 and 2015/16.

But there are three different types of A&E departments in England. Patients can go to major A&E units, the type you would normally think of when you picture someone going for emergency treatment; speciality units that deal with particular types of emergency, such as dentistry; and walk-in centres that deal with more minor injuries.

We don’t have figures as far back as 2000 on these separate types. But we do know that attendances at major A&E departments have gone up by 3 million since 2002/03. Attendances at specialist A&Es have risen by 88,000 since that year.  And visits to walk-in centres, which were recently introduced, have increased by more than 4 million since 2003/04.

Do we know how many need to be there?

In 2010 the Primary Care Foundation found that between 10% and 30% of cases turning up in A&E were ones that were regularly seen by GPs. It’s this figure that the Department of Health told us Mr Hunt was referring to when he said 30% of A&E visits don’t need to be made.

The report estimated that between 10% and 30% of A&E visits “could
 be
 classified
as
 primary 
care 
cases (types 
that
 are 
regularly
 seen 
in 
general
 practice)”. In other words, they’re cases that all GPs would be comfortable with even if they didn’t have any specialism in emergency medicine.

One of the report’s authors told us that the estimate referred specifically to major A&E units, rather than the walk-in centres or speciality units which also cater for accidents and emergencies.

So it’s not right to say that up to 30% of the extra nine million A&E visits since 2000 could be dealt with by a GP, as this would include the other types of A&E including walk-in centres which are specifically for dealing with more minor ailments. At most, the finding refers to 30% of the extra 3 million visits to major A&E units.

Other studies have found that some A&E patients could be dealt with in less urgent settings. The Royal College of Emergency Medicine found that around 15% of patients who attend A&E could be seen by community medical facilities if they were available within 24 hours.

In 3% of recorded diagnoses in A&E’s last year “nothing abnormal was detected”. Just over 11% of those whose treatment was recorded were listed as not receiving any treatment.

Patients aren’t doctors; it’s not always possible to know whether you need to go to a GP or A&E. Just because someone hasn’t received any treatment or could have been treated by a GP doesn’t mean that they shouldn’t have gone to A&E for help.

The Primary Care Foundation’s report noted that the proportion of A&E patients who could be seen by a GP if one was available on the day is “much higher” than those who could be seen outside of A&E if they had to wait several days for a GP to become available.

Do people go to A&E instead of GPs?

In 2013, the Royal College of Physicians told a committee of MPs that they believed there was a relationship between the availability of GP appointments and the numbers of people going to A&E. The Royal College of General Practitioners told the same committee that they questioned whether GPs had the capacity to take on more work.

A study by Imperial College London found that there was a link between whether or not patients could get an appointment with their GP within two days and whether they would go to A&E instead. The authors looked at 95% of GP surgeries in England in 2010/11. But they also pointed out that other smaller studies have not found the same link and that more work needs to be done in the area.

Around 85% of people report that they were able to get a GP appointment the last time they tried, according to the NHS’s GP Patient Survey. This has been decreasing since 2012, when it was around 88%.