GP or A&E - where do patients go when unwell and how can we better inform their choices?
Some people go to A&E and staff wonder why they’ve come because it’s obvious to them that it’s not an emergency and the person doesn’t need to be there.
Staff wonder why people didn’t just go to their GP instead. Meanwhile, patients worry about wasting the time of health services. They wonder how serious their problem is and whether they should bother any doctor with it. The problem does not go away and they get more and more worried so they go to A&E to get it sorted out as quickly as possible.
It’s clear that most people are doing their best to provide good health services and use services responsibly. Yet we still have a problem.
Policymakers try to help by funding NHS 111 to guide people to the best service for them, NHS Choices to help people learn about the best thing to do when faced with certain symptoms, and Choose Well to help people know what services are available locally. Yet we still have a problem.
The NIHR funded us to look into this situation because health services such as A&Es are facing increased demand. Finding ways of reducing demand from people who do not need these services could help these busy services to cope better. One of the things we did was work with the British Social Attitudes survey to ask a representative sample of the British population what they thought about seeking health care when faced with an unexpected health problem.
The 2018 British Social Attitudes survey consists of 3,879 interviews with a representative, random sample of adults in Britain and the questions featured in our research were asked of 2,906 respondents by the National Centre for Social Research and commissioned by the University of Sheffield.
Perceptions of A&E
Public satisfaction in A&E departments has remained steady over the past 20 years. We found that 86% of people thought that too many people use A&E when they do not need to. So it’s not just policy makers and those who provide health services who think there’s a problem here.
The ‘pull’ factor’: A&Es have attractive qualities
Our research showed some people favour A&Es over their local GP surgery. One in three people prefer not to make appointments, one in five people think A&E doctors know more than GPs, and one in six people think they can get tests done more quickly there than at their GPs. These people are much more likely to live in deprived areas and have no educational qualifications. What can we do about this? We can make appointments systems easier to navigate in general practice. People who lead difficult lives, and vulnerable groups, can find appointments systems much more difficult to deal with than others. Currently some general practices ask patients to call at 8.30am when they want an urgent appointment and then call the next day if the appointments have run out. If patients don’t want an urgent appointment, just a routine one, they may have to wait weeks. We might also need to educate people about the years of experience most GPs have, and make access to tests more efficient in general practice.
The ‘push factor’: general practice is not giving some people what they want
We found that half of the adult population of Britain thinks it’s hard to get an appointment with their GP and one in 10 did not have confidence in GPs at their surgery. The quality of GPs and access to GPs varies around the country. In another part of our research we talked to people who spoke positively about their GP, could get appointments easily, and so used their GP and not A&E. But this was not true for everyone and those having negative attitudes and experiences may end up at A&E because they couldn’t get an appointment, thought they wouldn’t get an appointment if they tried, or as a way to avoid their GP.
It’s clear that if we are to reduce numbers of patients heading to A&E when they could go to their GP, it’s important to strengthen general practice, and the valuable work doctors do there.
More information on the study is available on the NIHR Journals Library website.
Professor Alicia O’Cathain, School of Health and Related Research, University of Sheffield. Funded by NIHR to look at why people decide to call 999 and ask for an ambulance, or go to A&E, when they could have gone to their GP
The views and opinions expressed in this blog are those of the authors and do not necessarily reflect those of the NIHR, NHS or the Department of Health and Social Care.