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

Br J Gen Pract. 2014 Jul;64(624):e434-9. doi: 10.3399/bjgp14X680533.


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.

Keywords: access to health care; emergency departments; general practice; patient appointments; primary health care; urgent care.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Age Distribution
  • Ambulatory Care / statistics & numerical data
  • Appointments and Schedules
  • Cross-Sectional Studies
  • Emergency Service, Hospital / statistics & numerical data*
  • England
  • Female
  • General Practice / statistics & numerical data*
  • Health Care Surveys
  • Health Services Accessibility / statistics & numerical data*
  • Humans
  • Male
  • Patient Acceptance of Health Care / statistics & numerical data*
  • Sex Distribution