Exploring the relationship between general practice characteristics, and attendance at walk-in centres, minor injuries units and EDs in England 2012/2013: a cross-sectional study.
BACKGROUND
For several years, EDs in the UK NHS have faced considerable increases in attendance rates. Walk-in centres (WiCs) and minor injuries units (MIUs) have been suggested as solutions. We aimed to investigate the associations between practice and practice population characteristics with ED attendance rates or combined ED/WiC/MIU attendance, and the associations between WiC/MIU and ED attendance.


METHODS
We used general practice-level data including 7462 English practices in 2012/2013 and present adjusted regression coefficients from linear multivariable analysis for relationships between patients' emergency attendance rates and practice characteristics.


RESULTS
Every percentage-point increase in patients reporting inability to make an appointment was associated with an increase in emergency attendance by 0.36 (95% CI 0.06 to 0.66) per 1000 population. Percentage-point increases in patients unable to speak to a general practitioner (GP)/nurse within two workdays and patients able to speak often to their preferred GP were associated with increased emergency attendance/1000 population by 0.23 (95% CI 0.05 to 0.42) and 0.10 (95% CI 0.00 to 0.19), respectively. Practices in areas encompassing several towns (conurbations) had higher attendance than rural practices, as did practices with more non-UK-qualified GPs. Practice population characteristics associated with increased emergency attendance included higher unemployment rates, higher percentage of UK whites and lower male life expectancy, which showed stronger associations than practice characteristics. Furthermore, higher MIU or WiC attendance rates were associated with lower ED attendance rates.


CONCLUSIONS
Improving availability of appointments and opportunities to speak a GP/nurse at short notice might reduce ED attendance. Establishing MIUs and WiCs might also reduce ED attendance.
Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK.
Peter
P
Tammes
Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK.
Richard W
RW
Morris
Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK.
Emer
E
Brangan
Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, UK.
Kath
K
Checkland
Devon Partnership NHS Trust, Exeter, UK.
Helen
H
England
Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK.
Alyson
A
Huntley
Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Daniel
D
Lasserson
Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK.
Fiona
F
MacKichan
Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK.
Chris
C
Salisbury
Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK.
Lesley
L
Wye
Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK.
Sarah
S
Purdy
D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D004739:England; D005260:Female; D058006:General Practice; D006297:Health Services Accessibility; D006302:Health Services Research; D006801:Humans; D008297:Male; D013222:State Medicine
emergency care systems, emergency departments; emergency care systems, primary care; emergency department utilisation; primary care; statistics