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After-hours primary care

The provision of after-hours primary care in the USA was discussed in a number of articles and letters published recently in the Annals of Internal Medicine. In a response to the articles. I discussed the relevance to the USA of England's experience in providing after-hours primary care. Many of the innovations recommended by by the authors of one of the articles in the Annals of Internal Medicine for the provision of after-hours primary care in the U.S. health care system are already present in England's NHS. These innovations are aimed at improving the care of people with emergencies and reducing pressures on emergency departments.

For example, all residents of England have access to free after-hours primary care services from the NHS, either provided by their own primary care physician or by their local primary care trust. Despite the wide availability of primary care services and a readily accessible 24-hour helpline, patient attendance at emergency departments, urgent care centres,  and minor injury units in England continues to rise with a 35% increase from 15.3 million first attendances from 2003-2004 to 20.7 million in 2010-2011). The lesson from England for countries with more fragmented and less widely available after-hours primary care services is that a health system can strive hard to improve access to after-hours primary care, but this by itself may not be enough to curtail the demands placed on emergency departments.

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