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GP care 'link to child admissions'

Published 11/05/2015

GPs' work reforms corresponded with a rise in potentially avoidable child emergency admissions, researchers claim
GPs' work reforms corresponded with a rise in potentially avoidable child emergency admissions, researchers claim

Reforms to GPs' working practices in 2004 corresponded with a rise in potentially avoidable emergency admissions for children , a study has found.

Researchers at Imperial College London said the changes - brought about under Labour and which altered GP contractual hours, allowing them to opt out of providing out-of-hours (OOH) care - coincided with an 8% increase in short-stay admission rates for chronic conditions such as diabetes and asthma.

The study authors said this showed "clear evidence" that children whose care was not prioritised by their family doctor had to turn to the emergency services instead.

This was equivalent to 8,500 additional admissions a year and well above the 3% annual increasing trend, they said.

Their analysis of a ll 7.8 million children under 15s' emergency admissions between 2000 and 2012 found more than half (4.1 million) were short-stay admissions and 21% (1.7 million) were for chronic conditions.

Dr Sonia Saxena, a practising GP and the study's lead author, said: "Chronic conditions in children require good quality management in primary care and are sensitive to changes in GP working patterns. Avoidable admissions can be detrimental to the child, inconvenient to their families and expensive for the NHS.

"GPs have worked hard to achieve significant health gains in adults as a result of these policies. Now we have clear evidence that the unintended consequences have been that children whose care was not prioritised have had to turn to the emergency services, which in many cases results in poorer health outcomes in children and waste in the health system."

The research, published in Annals of Family Medicine, is on a highly contentious topic that featured in the General Election and comes as emergency admissions have been rising for more than 10 years.

Dr Richard Vautrey, GP committee deputy chair at the British Medical Association (BMA), insisted GPs were working harder than ever before.

He said: "A decade ago OOH services were under incredible strain because they were staffed by GPs who often worked an unsafe number of hours both during the day and right through the night.

"The contract changes in 2004 led to new organisations taking over the management of OOH services. However, many of the same GPs continued to work within them providing care to local patients.

"This research ignores the important fact that since 2004 there has been a substantial increase in pressure on the NHS from rising patient demand, falling resources and staff shortages that have particularly affected general practice.

"We have returned to the situation we faced a decade ago, with services under unsustainable pressure. In addition, walk-in-centres, NHS 111 and simplistic but counter-productive A&E waiting targets have failed completely to manage and reduce demand on NHS services, including general practice."

Professor Maureen Baker, chairwoman of the Royal College of GPs, said: "This research is largely based on ungrounded assumptions - there is no evidence to suggest a causal link between out of hours GP access and either increased emergency attendances or short-stay admissions for children.

"Any increase is most likely due to some hospital doctors taking a more cautious approach to admitting children for overnight observation, a response to pressure to meet the A&E four-hour target, and a lack of ability to discharge patients back into the community.

"The health of our child and young patients is a priority for GPs.

"What is clear is that, according to the latest GP Patient Survey, 45% of people do not know how to access GP services out of hours. More needs to be done to raise awareness of these, so that patients know where to turn when they - or their children - fall ill in the evenings or at weekends."

A Department of Health spokesman said: "The 2004 GP contract broke the personal link between doctor and patient, piled on red tape and put huge pressure on A&Es.

"By 2020 we'll ensure everyone can see a family doctor seven days a week, empowering hard-working GPs as the cornerstone of the NHS."

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