Long-term health conditions drive A&E visits, not lack of GP services

Rising accident and emergency attendance rates are driven by patients' long term health conditions*, and are not related to lack of GP provision, according to a study by Queen Mary University of London of more than 800,000 patients in east London.

Lead researcher Dr Sally Hull from Queen Mary said: "The pressures on emergency departments, especially during winter, are enormous. When departments are very busy, with long waits and difficulties finding beds for people needing admission, it is easy to seek scapegoats and suggest that poorly functioning GP services are to blame for the crisis.

"Contrary to the popular narrative that people are using emergency departments rather than their GP surgery, our research shows that this is not the case. The same people who attend their GP surgery a lot also attend their emergency department a lot. This is largely because they have multiple long term health conditions, both mental and physical, and it is these conditions, along with an ageing population, which are driving the high attendance rates.

"These effects are exacerbated by socioeconomic deprivation. People in the most socially deprived areas develop long term health conditions 10 years earlier than those who are least deprived. These factors combine to put pressure on emergency departments."

Rates of emergency department (ED) attendance have more than tripled over the past 50 years, from 105/1,000 population in 1961 to 373/1,000 population in 2015-6. Previous studies found that socioeconomic deprivation was a major influence on ED attendance, but the studies were based on GP practice level and population data.

For the first time in the UK, the study, published in the British Journal of General Practice, looks at anonymised data from individual patients, and links their separate GP and ED records to get a more accurate picture of attendances over a two year period.

The team analysed data from 819,590 GP registered patients in 136 practices in the east London Clinical Commissioning Groups of Newham, Tower Hamlets and City & Hackney and found:

• Having multiple long term health conditions was the strongest predictor of ED attendance. This and social deprivation are the major drivers of ED attendance.

• There was a six-fold increase in ED attendance rates in those with four or more long term health conditions, compared to those with no such conditions.

• People in the most deprived areas with four or more long term conditions, who also smoked, had almost three times the rate of ED attendance, compared to the same type of person living in the least deprived areas.

• Attendance rates for the most deprived population group (366/1000 population) were 52 per cent higher than those for the least deprived (240/1000).

• Patients with more attendances at EDs also have higher GP consultation rates - this suggests that the year on year rise in ED attendance is not explained by poor access to primary care.

• Patient experience of GP access, reported at practice level, did not predict use of ED, unlike findings from previous studies.

Dr Sally Hull added: "There are suggestions that emergency department units can be reduced and replaced with community-based support. This would require investment in both social care and community health services, and close alignment with the perceived needs of patients seeking urgent care. It is crucial that we carry out studies like this to understand why people attend emergency departments, and to identify the services which can be safely taken over by GP and community services."

The authors caution that, as the study is set in east London, it is not representative of the country as a whole. The findings are relevant to other inner urban areas with similar levels of material deprivation and ethnic minority populations.

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For more information, please contact:

Joel Winston
Public Relations Manager - Medicine and Dentistry
Queen Mary University of London
Tel: +44 (0)207 882 7943
Mobile: +44 (0)7970 096 188
j.winston@qmul.ac.uk

* The conditions included were: asthma, atrial fibrillation, cancer, coronary heart disease, chronic kidney disease, chronic obstructive pulmonary disease, dementia, depression, diabetes, epilepsy, heart failure, hypertension, learning disabilities, serious mental illness, peripheral arterial disease and stroke and transient ischaemic attack.

Research paper: Population and patient factors affecting Accident and Emergency Department attendance in London: an analysis of linked primary and secondary care records. Sally A Hull, Kate Homer, Kambiz Boomla, John Robson, Mark Ashworth. British Journal of General Practice. doi: 10.3399/bjgp18X694397

Available here after the embargo lifts: https://doi.org/10.3399/bjgp18X694397

Queen Mary University of London is one of the UK's leading universities with 23,120 students representing more than 160 nationalities.

A member of the Russell Group, we work across the humanities and social sciences, medicine and dentistry, and science and engineering, with inspirational teaching directly informed by our research. In the most recent national assessment of the quality of research, we were placed ninth in the UK amongst multi-faculty universities (Research Excellence Framework 2014).

As well as our main site at Mile End - which is home to one of the largest self-contained residential campuses in London - we have campuses at Whitechapel, Charterhouse Square, and West Smithfield dedicated to the study of medicine and dentistry, and a base for legal studies at Lincoln's Inn Fields.

Queen Mary began life as the People's Palace, a Victorian philanthropic project designed to bring culture, recreation and education to the people of the East End. We also have roots in Westfield College, one of the first colleges to provide higher education to women; St Bartholomew's Hospital, one of the first public hospitals in Europe; and The London, one of England's first medical schools.