Extending primary care hours is linked to fewer emergency department visits

Most general practitioners in the UK provide primary care services from 8:30am to 6:30pm, and patients who need care outside of these hours often turn to emergency departments; an estimated 26.5% of ED visits in England follow unsuccessful attempts to access primary care. In an attempt to lower the costs associated with ED visits, NHS England (Greater Manchester) provided £3.1 million to enable 56 primary care practices in the Greater Manchester area to provide additional evening and weekend urgent and routine appointments during 2014. Using routinely collected data from 2011 to 2014, Whittaker and colleagues compared the change in the number of ED visits by the 346,024 patients of the extended-access practices to the 2,596,330 patients from 469 practices providing routine access.

The researchers found that patients registered to the extended-access practices had a 26.4 percent relative reduction in patient-initiated emergency department visits for minor problems compared with patients from practices providing routine access, with 10,933 fewer such visits per year. For every 3 booked additional primary care appointment slots added to a practice's schedule, 1 ED visit was avoided. Moreover, there was a 26.6 percent relative reduction in costs of minor ED visits, saving £767,976. However, there was no statistically significant relative reduction in overall ED visits, and on the basis of emergency department savings alone, extending primary care is unlikely to be cost-effective, the researchers concluded. The study did not have enough data to perform a formal cost-effectiveness analysis, however, and no data were collected on patient health outcomes. As a result, the analysis does not take into consideration the potential benefits to those patients using additional appointments who would not have visited emergency departments otherwise.

"Our study suggests that extending opening hours in primary care may be a useful addition to policies aiming to reduce pressures on hospital services, potentially reducing patient-initiated use of the emergency department for minor problems -- but at a significant cost," the authors say.