Decrease in emergency admissions via GPs

EMERGENCY admissions to hospital via A&E departments increased markedly in England over a ten year period to 2011 while those via GPs decreased, according to analysis published in the Journal of the Royal Society of Medicine.

Researchers from Imperial College London estimate that the annual number of emergency hospital admissions via A&E departments rose by 72 per cent (2.1 million to 3.6 million) between 2001/2 and 2010/11. In the same period there was a 17 per cent decrease in admissions via GPs (1.12 million to 0.93 million).

Several factors may explain the findings including demographic changes in the English population, lowering thresholds in A&E departments for admitting patients, increased failure of management in primary care and outpatient settings, the growth of acute medicine as a specialty and changes in patients’ healthcare-seeking behaviour.

Commenting on the findings, Thomas Cowling, lead author and NIHR Doctoral Research Fellow from the School of Public Health at Imperial College London, said: "The decision to admit patients to hospital increasingly came from A&E staff, rather than GPs. This trend is curious and the explanation is currently unclear.

"Whatever the explanation, the role of A&E departments as portals for emergency admission has grown, despite efforts to reduce A&E attendance rates and national recommendations to support direct admission to acute medical care.

"A&E staff now have increased responsibility as gatekeepers for inpatient care and as care coordinators, which is not reflected in how A&E departments’ activity is measured or reimbursed."

The researchers believe that low recruitment into higher specialty training and unfilled consultant posts have compounded the problem.

Cowling added: "New models of urgent care services that employ GPs in or alongside A&E departments as gatekeepers to specialist urgent care ought to be evaluated before they are scaled up to avoid further ad hoc developments. This also applies to the current government’s pilot scheme of extended opening hours in general practice."