Choice of GP cuts emergency admissions

Patients who see the GP of their choice at their doctor's surgery are less likely to go to hospital as an emergency admission, a new study has found.

The study, led by the University of Leicester, found seeing your "preferred GP" helped reduce emergency hospital admissions.

Led by Dr John Bankart, a research fellow in medical statistics at the University, the study was funded by the NHS and is published in Emergency Medical Journal.

The findings, by researchers in the university's Department of Health Sciences, showed a correlation between patients being able to see a preferred GP and emergency hospital admissions.

Dr Bankart said: "We undertook a study to identify characteristics of general practices associated with emergency hospital admission rates.

"The study was undertaken in two primary care trusts, Leicester City and Leicestershire County and Rutland, and included 145 general practices.

"Hospital admission data were used to calculate the rate of emergency admissions for two consecutive years (2006/07 and 2007/08), and we studied the impact of practice characteristics and patient characteristics on admission rates.

"We found that practice characteristics, like being a shorter distance from hospital and smaller list sizes and patient characteristics such as a higher proportion of older people, white ethnicity, increasing deprivation, and female gender, were associated with higher admission rates."

He said there was no link with measures of clinical or organisational performance, but there was an association between patients reporting being able to see a particular GP and admission rates.

"As the proportion of patients able to consult a particular GP increased, emergency admission rates declined.

"We concluded that the patient characteristics of deprivation, age, ethnicity and gender are important predictors of admission rates.

"Larger practices and greater distance from a hospital have lower admission rates. Being able to consult a particular GP, an aspect of continuity, is associated with lower emergency admission rates."

Dr Bankart and his GP co-author Professor Richard Baker said they thought there were two main reasons why improved continuity helped reduce emergency admission rates.

"There is good evidence that higher continuity with your GP is associated with greater trust in the GP," he said.

"People with chronic conditions, particularly problems they are worried about, prefer to see a doctor they know and trust.

"When someone becomes sufficiently ill to make hospital admission an option, but not so ill as to make hospital admission the only option, if the patient is able to consult the GP they trust the likelihood that they will choose to go to hospital instead will decrease.

"On the other hand, if the patient does not have a GP they trust, or is unable to consult with the GP they trust, it is more likely they will choose the option of hospital admission."

They said if a GP knows a patient well, their recommendations on clinical management will be better tailored to the individual patient, and a patient who trusts their GP is more likely to follow their advice.

But Dr Bankart said the study also showed GP practices will struggle to impact on hospital admission rates, given that many of the factors influencing hospital admissions are outside their control.

These include the higher proportion of elderly, white ethnicity, increasing deprivation and distance from hospital.

"This finding is important because small changes in admission rates have substantial economic consequences, and it points to potential interventions to reduce emergency admission rates," he added.