Access to general practice and visits to accident and emergency departments in England: cross-sectional analysis of a national patient survey

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. Aim 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. Design and setting Cross-sectional analysis of a national survey of adults registered with a GP in England. Method 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. Conclusion 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.