title: Can increased primary care access reduce demand for emergency care? Evidence from England's 7-day GP opening.
abstract: Restricted access to primary care can lead to avoidable, excessive use of expensive emergency care. Since 2013, partly to alleviate overcrowding at the Accident & Emergency (A&E) units of hospitals, the UK has been piloting 7-day opening of General Practitioner (GP) practices to improve primary care access for patients. We evaluate the impact of these pilots on patient attendances at A&E. We estimate that 7-day GP opening has reduced A&E attendances by patients of pilot practices by 9.9% with most of the impact on weekends which see A&E attendances fall by 17.9%. The effect is non-monotonic in case severity with most of the fall occurring in cases of moderate severity. An additional finding is that there is also a 9.9% fall in weekend hospital admissions (from A&E) which is entirely driven by a fall in admissions of elderly patients. The impact on A&E attendances appears to be bigger among wealthier patients. We present evidence in support of a causal interpretation of our results and discuss policy implications.
authors.affiliation: Department of Economics, University of Sussex, United Kingdom; CEP, LSE, United Kingdom. Electronic address: p.dolton@sussex.ac.uk.
authors.forename: Peter
authors.initials: P
authors.lastname: Dolton
authors.affiliation: Department of Economics, University of Sussex, United Kingdom. Electronic address: v.pathania@sussex.ac.uk.
authors.forename: Vikram
authors.initials: V
authors.lastname: Pathania
mesh_terms: D004632:Emergency Medical Services; D004636:Emergency Service, Hospital; D004739:England; D058005:General Practitioners; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006801:Humans; D011320:Primary Health Care
keywords: A&E; ER; GP; NHS; Physician incentives; Primary care