Minor units take a growing share of emergency department attendances

BMJ 2013; 347 doi: (Published 03 December 2013) Cite this as: BMJ 2013;347:f7233
  1. Gareth Iacobucci
  1. 1BMJ, London, UK

Attendances at emergency departments in England are rising faster than population growth, new figures have shown.

Statistics for 2012-13 from the Health and Social Care Information Centre (HSCIC) show an 11% growth in emergency department attendances since four years ago (2008-09), compared with a population growth of 3.2% during the same period.

There were 21.7 million emergency department attendances in 2012-13, compared with an estimated 340 million consultations in general practice.

But although the HSCIC identified “striking consistencies” in patterns of emergency department activity over time, the latest figures show a higher proportion of cases being dealt with by minor units than was the case four years ago. Minor units dealt with almost 32% of attendees in 2012-13, up from 28% in 2008-09, whereas major units dealt with about 66%, down from 69%.

Some 63% of people who attended minor units in 2012-13 were aged under 40 years, up from 59% in 2008-09. Conversely, 12% were aged over 64 years, down from 14% four years ago.

In major units, 54% of attendees were under 40 years, down from 57% in 2008-09, whereas 21% were over 64 years, up from 19% in 2008-09.

The HSCIC said the focus on the accident and emergency (December 2013) report would inform the current debate about the pressure on emergency departments,1 which has led to a major review of urgent and emergency care services, led by NHS England’s medical director, Bruce Keogh 2

It said current trends were part of a consistent pattern that has emerged over the past few years. For example, figures available from 2008-09 onwards showed that attendances at emergency departments peaked slightly between April and June, with most occurring during normal working hours of 9 am to 6 pm.

In addition, figures from 2009-10 onwards showed that around 20% of emergency department attendees are admitted to hospital, but this increases to almost 50% for people over 64 years.

Almost two thirds of emergency department attendees from 2009-10 onwards referred themselves, whereas around 5% were referred by a GP. In the same time period, about a third of attendees received guidance or advice only.

Kingsley Manning, chairman of the HSCIC, said he hoped that the publication of the figures would help shed light on the emergency department debate.

Emergency care is “a complex area that statistics alone cannot fully explain—but good quality information is vital towards gaining a clear understanding of patterns and trends in activity over time,” he said.

Responding to a question from the BMJ on how the NHS and policy makers should use the data, Manning added: “I think we would like to challenge some easily made assertions by policy makers and individuals which can be distressing for patients and diverting for the press and everybody else.

“It is supporting the work of NHS England and elsewhere in terms of trying to think about and improve the management and operation of A&E [emergency] departments, and where they should sit in the wider context. Frankly policy needs to be made on the firmest foundation and our job is to provide policy makers with the best evidence we possibly can.”

Health minister Lord Howe said that emergency departments were “performing well and meeting national targets, despite seeing more patients. But, as these data show, we know there’s more pressure on the system and we’ve taken action to address this.

“We’re investing £400m [€483m; $656m] in measures to relieve short term winter pressures and, longer term, we’re integrating health and social care and bringing back the link between GPs and elderly patients, to enable more people to receive the treatment they need away from A&E [the emergency department].”


Cite this as: BMJ 2013;347:f7233


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