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LETTERS: Azeem Majeed Role of hospitals in NHS must not be undervalued BMJ 1998; 317: 1653 [Full text]

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GPs and Hospitals - a re-estimation re-estimated

Tom Hennell   (14 December 1998)

GPs and Hospitals - a re-estimation re-estimated 14 December 1998
Tom Hennell, Strategic Analyst NHS Executive North West Send response to journal: Re: GPs and Hospitals - a re-estimation re-estimated	EDITOR - We should be grateful to Majeed for his re-estimation of the proportion of medical care that takes place within general practice(1). His calculation of 'about 70%' is, however, to low; as he has extracted the wrong figure from the 1991 fourth national survey of 'Morbidity Statistics from General Practice'. The stated figure of 2.9 per person year is the 'doctor contact rate'. The calculated 'consultation rate' - allowing that there may be consultations for a range of separate conditions within the same visit - was 3.5 per year; or 3.6 per year allowing for under-recording in MSGP4(2). For an annual estimate; we start with the total 1991 English population, minus prisoners and service personnel - 48 million. This should be inflated by 3.5%, for duplicate registrations; and then multiplied by 3.6 to give a projection of face-to-face consultations; which can be further increased by 8% to allow for telephone consultations(3). The resulting total is 193 million - or 76% of NHS medical care. A better comparison would be to look at estimates of complete episodes of care. Here the estimated general practice rate from MSGP4 was 2.0 per person year - 'New and first ever episodes'(2). Adjusted as before, this projects 111 million general practice episodes - compared to a hospital estimated total for 1991/92 of 23.5 million - 3.5 million emergency inpatients (4), 11 million Accident and Emergency first attenders(5), and 9 million referral outpatient attendances(5). This suggests that the proportion of medical episodes that take place in general practice may be close to 83% - which I believe corresponds to Chisholm's reference to "90% of all episodes of health care"(6). Tom Hennell, Strategic Analyst NHS Executive - North West. Birchwood. Warrington WA3 7QN 1. Majeed, A. Role of hospitals in NHS must not be undervalued BMJ 1998; 317: 1653 2.Royal College of General Practitioners, Office of Population Censuses and Surveys, Department of Health. Morbidity statistics from general practice: fourth national study, 1991-92. London: HMSO , 1995. 3. Office of Population Census and Surveys. General Household Survey 1991. London HMSO 1993. 4. Department of Health. Hospital Episode Statistics 1991-92. Department of Health . London 1994 5. Outpatients and ward attenders for England 1991-92. Department of Health. London 1993. 6. Chisholm J. Primary care and the NHS white papers. BMJ 1998; 316: 1687-1688