Can increased primary care access reduce demand for emergency care? Evidence from England's 7-day GP opening

J Health Econ. 2016 Sep;49:193-208. doi: 10.1016/j.jhealeco.2016.05.002. Epub 2016 Jun 15.


Restricted access to primary care can lead to avoidable, excessive use of expensive emergency care. Since 2013, partly to alleviate overcrowding at the Accident & Emergency (A&E) units of hospitals, the UK has been piloting 7-day opening of General Practitioner (GP) practices to improve primary care access for patients. We evaluate the impact of these pilots on patient attendances at A&E. We estimate that 7-day GP opening has reduced A&E attendances by patients of pilot practices by 9.9% with most of the impact on weekends which see A&E attendances fall by 17.9%. The effect is non-monotonic in case severity with most of the fall occurring in cases of moderate severity. An additional finding is that there is also a 9.9% fall in weekend hospital admissions (from A&E) which is entirely driven by a fall in admissions of elderly patients. The impact on A&E attendances appears to be bigger among wealthier patients. We present evidence in support of a causal interpretation of our results and discuss policy implications.

Keywords: A&E; ER; GP; NHS; Physician incentives; Primary care.

MeSH terms

  • Emergency Medical Services*
  • Emergency Service, Hospital
  • England
  • General Practitioners*
  • Health Services Accessibility*
  • Health Services Needs and Demand*
  • Humans
  • Primary Health Care