Hospital emergency departments bear brunt of change to GPs' out of hours contracts
New research by Warwick Medical School at the
University of Warwick has found clear evidence to support the view
that hospital emergency departments are facing increased demands
which coincides with the changes to the GP contract in 2004. That
change led to a number of GPs transferring out of hours care to
Primary Care organisations.
The Warwick researchers Dr Joanne Fisher, and Professor Matthew Cooke, looked at patient numbers in two hospitals in the Heart of England NHS Foundation Trust (Heartlands Hospital in Birmingham and Solihull Hospital). They found the following changes since October 2004:
The Warwick researchers praise the Heart of England NHS Foundation Trust's response to this increased demand. At both Hospitals the Trust has established out of hours GP services located immediately alongside the Hospital's emergency departments allowing patients to be seen by the physician with the most appropriate skills for their condition. The Trust is trying two models. In the Birmingham Hospital the GP out of hours service is immediately alongside but clearly separate from the A&E service. In the case of Solihull the Trust has just opened a new GP out of hours service in the same area as the Hospital's A&E department and having a shared reception. Patients are allocated to a GP or an A&E clinician according to their needs, providing the patients with a single seamless service with no need to be passed from one reception desk to another.
Professor Matthew Cooke, who works at both Warwick Medical School and Heart of England NHS Trust, said: "The new services at both sites are responding to the changes that are occurring in how patients seek emergency care. By working together, primary care and the emergency department can ensure that all patients are seen by the most appropriate clinician."
The Warwick researchers Dr Joanne Fisher, and Professor Matthew Cooke, looked at patient numbers in two hospitals in the Heart of England NHS Foundation Trust (Heartlands Hospital in Birmingham and Solihull Hospital). They found the following changes since October 2004:
- Out of hours attendances at those hospital emergency departments had increased 27%
- There was a 9% increase in self referrals
- In particular attendances for less severe conditions - of the
sort that might be suitable for care by a GP had increased
51%
- Over the same period the number of attendances for major illnesses or trauma (the sort of illness or injury in which patients would usually always elect to go to an emergency department) hardly altered at all
- One of the biggest increases was seen in the number of parents bringing in children with respiratory conditions. The most common problem seen by GPs in the out of hours period.
The Warwick researchers praise the Heart of England NHS Foundation Trust's response to this increased demand. At both Hospitals the Trust has established out of hours GP services located immediately alongside the Hospital's emergency departments allowing patients to be seen by the physician with the most appropriate skills for their condition. The Trust is trying two models. In the Birmingham Hospital the GP out of hours service is immediately alongside but clearly separate from the A&E service. In the case of Solihull the Trust has just opened a new GP out of hours service in the same area as the Hospital's A&E department and having a shared reception. Patients are allocated to a GP or an A&E clinician according to their needs, providing the patients with a single seamless service with no need to be passed from one reception desk to another.
Professor Matthew Cooke, who works at both Warwick Medical School and Heart of England NHS Trust, said: "The new services at both sites are responding to the changes that are occurring in how patients seek emergency care. By working together, primary care and the emergency department can ensure that all patients are seen by the most appropriate clinician."