GPs in A&E could help tackle rise in emergency hospital admissions

BMJ 2010; 341 doi: (Published 06 July 2010) Cite this as: BMJ 2010;341:c3618
  1. Adrian O’Dowd
  1. 1London

    The NHS is struggling to meet an almost 12% rise in emergency hospital admissions in the past five years that is costing an extra £330m a year, according to a report.

    GPs and community services could be the answer to reducing this expensive trend, says the report, published on 5 July by health policy think tank the Nuffield Trust.

    The report shows that the number of emergency admissions in England rose by 11.8% between 2004-05 and 2008-09 (from around 4.4 million to 4.9 million admissions)—resulting in a cumulative total for five years of around 1.35 million extra admissions.

    For the analysis, the authors used hospital episode statistics from April 2004 to March 2009 to examine monthly emergency admissions. All hospitals in England were covered.

    Treating these extra patients in emergency hospital care is estimated to cost the NHS an additional £330m (€398m, $499m) per year, says the report. Emergency admissions now make up 35% of all hospital admissions in England, at an overall cost of around £11bn to the annual NHS budget.

    The Nuffield Trust analysis found that the rise in emergency admissions was linked to a dramatic increase in the number of short stay admissions caused partly by a lowering of the clinical threshold for emergency admissions.

    Substantial variation was found between NHS hospital trusts; some had reduced their emergency admissions by up to a third over the five years, whereas in others they almost doubled.

    Advances in medical care and management had reduced the length of time patients stayed in hospital, which freed up more beds and allowed doctors to admit more patients.

    This expensive cycle could be broken by creating better out of hospital care and preventive care, said the authors.

    Jennifer Dixon, director of the Nuffield Trust and co-author of the report, said, “Reversing this unsustainable rise in emergency admissions must be the number one priority for the NHS in England—any reform to the health service that does not tackle this will fail.

    “This cost could be avoided by preventing ill health through better care by GPs, community care services or social care, and better co-ordination of care between doctors in hospital and general practice.”

    Reasons for the dramatic rise in emergency admissions could include the effect of NHS targets, the ageing population, and variations across different hospitals, said the authors.

    The report recommends that commissioning GPs and managers review how clinical decisions to admit patients to hospital are made and improve them, for example through greater use of primary care doctors in accident and emergency.

    The College of Emergency Medicine welcomed the report’s suggestions on how emergency care services could be improved. But John Heyworth, president of the college, said, “It is fundamentally incorrect to assume that admissions for less than 24 hrs are unnecessary or financially inefficient.

    “In fact, the opposite applies—a properly staffed emergency department represents a highly cost efficient system with optimal use of diagnostics and informed decision making ensuring high quality safe care.”

    Health secretary Andrew Lansley said, “We need a more integrated approach to NHS care. It’s an approach which would ensure patients are not treated like drones in a production line but are given the best care at every point of their journey.”


    Cite this as: BMJ 2010;341:c3618


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