title: Access to general practice and visits to accident and emergency departments in England: cross-sectional analysis of a national patient survey.
abstract: BACKGROUND
  The annual number of unplanned attendances at accident and emergency (A&E) departments in England increased by 11% (2.2 million attendances) between 2008-2009 and 2012-2013. A national review of urgent and emergency care has emphasised the role of access to primary care services in preventing A&E attendances.
  
  
  OBJECTIVE
  To estimate the number of A&E attendances in England in 2012-2013 that were preceded by the attending patient being unable to obtain an appointment or a convenient appointment at their general practice.
  
  
  METHODS
  Cross-sectional analysis of a national survey of adults registered with a GP in England.
  
  
  METHODS
  The number of general practice consultations in England in 2012-2013 was estimated by extrapolating the linear trend of published data for 2000-2001 to 2008-2009. This parameter was multiplied by the ratio of attempts to obtain a general practice appointment that resulted in an A&E attendance to attempts that resulted in a general practice consultation estimated using the GP Patient Survey 2012-2013. A sensitivity analysis varied the number of consultations by ±12% and the ratio by ±25%.
  
  
  RESULTS
  An estimated 5.77 million (99.9% confidence interval = 5.49 to 6.05 million) A&E attendances were preceded by the attending patient being unable to obtain a general practice appointment or a convenient appointment, comprising 26.5% of unplanned A&E attendances in England in 2012-2013. The sensitivity analysis produced values between 17.5% and 37.2% of unplanned A&E attendances.
  
  
  CONCLUSIONS
  A large number of A&E attendances are likely to be preceded by unsuccessful attempts to obtain convenient general practice appointments in England each year.
authors: Department of Primary Care and Public Health, Imperial College London, London.
authors: Thomas E
authors: TE
authors: Cowling
authors: Department of Primary Care and Public Health, Imperial College London, London.
authors: Matthew J
authors: MJ
authors: Harris
authors: Department of Primary Care and Public Health, Imperial College London, London.
authors: Hilary C
authors: HC
authors: Watt
authors: Department of Primary Care and Public Health, Imperial College London, London.
authors: Daniel C
authors: DC
authors: Gibbons
authors: Department of Primary Care and Public Health, Imperial College London, London.
authors: Azeem
authors: A
authors: Majeed
mesh_terms: D000328:Adult; D017677:Age Distribution; D000553:Ambulatory Care / Q000706:statistics & numerical data; D001071:Appointments and Schedules; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D004739:England; D005260:Female; D058006:General Practice / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D017678:Sex Distribution
keywords: access to health care; emergency departments; general practice; patient appointments; primary health care; urgent care