Extended GP opening hours could reduce A&E attendance

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Extending opening hours is unsustainable Extending opening hours is unsustainable without boosting the workforce

Extended opening hours in general practice can lead to reductions in attendances to A&E settings, a study published in PLoS Med has found, although major commitments to the practice nursing workforce will be needed to benefit the public.

As part of the study, 56 practices in Manchester offered additional routine and urgent appointments during evenings and weekends in 2014. The appointments lasted 10 to 15 minutes and amounted to an average of 35 hours additional opening per week.

A total of 51,465 additional appointments were offered as part of the scheme, equating to 152 extra appointments per 1000 people registered over the year. There was a 26.4% relative reduction in ‘minor’ A&E visits, or 10,933 fewer visits, compared to areas where practices did not offer additional appointments.

‘There were practices with extended hours, and there was a decline in A&E attendance from what I gathered from some of the findings,’ said Kathryn Yates, professional lead for primary care at the Royal College of Nursing. ‘So obviously that’s having some local effect. Whether you could then replicate that on an England-wide level is subject to lots of issues associated with funding, having practitioners with the right skills in the right place and enabling practitioners who are skilled and competent to be able to deliver that service.’

Ms Yates suggested that to deliver the seven-day services, workforce planners would need to concentrate on ‘the three Rs: recruitment, retention and the return to general practice,’ to ensure that the workforce was equipped to provide the additional hours.

She also stated that extended hours would be largely unhelpful without improving patient education around the availability of services. ‘If you are providing an out of hours walk-in service by appointment or walk in, one of the crucial elements is how you enable people to think differently to not go to A&E,’ she added. ‘If people don’t know whether they should access it, then how do you enable people to think differently about their behaviours?’

The authors of the study shared Ms Yates’ view that while beneficial, workforce planners would need to ensure that primary care settings were supported to extend opening hours. ‘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 the emergency department for minor problems – but at a significant cost,’ they commented.

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Comments

Some of the issues of practices not being well used on weekends is lack of information to patients and other care providers . GP practices in the area I work were opening using Prime minsters additional funding and no one was aware of it.
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Our GP Practice had to cease our opening hours on Saturday mornings due to very poor attendance and sometimes no attendance within the 4 hours of our opening on Saturday mornings
From my own experience working patients like myself often use Saturday as shopping days and Sundays as rest days
I for one is in favour of extended hours to accommodate working patients during the weekdays as we do under GP rotation system. However I believe the opening hours pm to be capped at 8pm, to extend the pm hours beyond this for us will produce a health and safety risk for evening staff
I believe some widespread health education is essential for all new comers to the UK on the purpose of the NHS - using the health care services provided within the NHS and better use be made of other health care provider associated organisations such as the local Pharmacy service
The NHS cannot financially provide for all the health needs and requirements of the population and it may well be time for a different approach be made to its top up funding - that is service payment for some illnesses and treatments or overall health rationing
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Increasing the access to primary care over a seven day period and extending it into later in the day will clearly have some impact on Emergency Department attendances. At least 35% of patients attend the ED as a result of being unable to access timely primary care.

The key challenge is however how to adequately staff primary care which is exactly the same issue facing emergency departments. There is a major deficit in the nursing workforce, the clinical talent pool is getting ever smaller with skilled senior nurses from both EDs and general practice electing to take early retirement or reduce their NHS contracted work and pick up well paid locum work. The same applies to our medical colleagues who no longer see either emergency medicine or general practice to be attractive career options.

The urgent issue for the entire NHS is staff retention with the priority specialities being emergency care and general practice.

Mike Paynter
Somerset
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