Skip to main content

Unscheduled care in the UK and USA

In a publication in the Annals of Internal Medicine, Thomas Cowling and colleagues describe how discussion of acute unscheduled care in the United States resembles the debate on the same topic in England, where the National Health Service is conducting a comprehensive review of unscheduled care services.

In England, general practices staffed by primary care physicians and hospital emergency departments (EDs) form the 2 “silos of acute care delivery”. Approximately 9% of patients who try but are unable to obtain a convenient appointment at their general practice office subsequently visit an emergency department. Consequently, recent national policies have attempted to improve access to general practice, using financial incentives to reduce demand for acute unscheduled care at emergency departments.

A potential unintended consequence of expanding alternative care settings is that the “question of where patients with acute care needs should go for unscheduled care” becomes more confusing for patients themselves, which has been observed in the National Health Service. An increase in the supply of acute unscheduled care services could also generate additional demand for unscheduled care, presenting another undesired result of this policy.

In research in West London, we are evaluating the impact of GP-led urgent care centres and of using GPs as a 'fron-end' to emergency departments. Published papers have described the model and looked at attendances at these services among adolescents. Future papers will examine other measures such as prescribing patterns, use of investigations and impact on acute admissions.

Comments

Popular posts from this blog

Improving how secondary care and general practice in England work together: the NHS Standard Contract

Due to the increasing pressures on general practices within the National Health Service in England, the interface between primary and secondary care, and the division of labour between these, has become an important issue. This has long been an area prone to difficulties and conflict, the consequences of which can directly impact the quality and safety of patient care, particularly for patients with chronic conditions who regularly transition between these two sectors. In an article published in the Journal of the Royal Society of Medicine, Amy Price and I explore the measures recently implemented in the NHS Standard Contract which aim to target common issues at the primary–secondary care interface, with an aim to reducing inappropriate general practitioner workload in England. We discuss the context behind the implementation of the NHS Standard Contract as well as current concerns and areas for further consideration.

The current crisis in primary care means the NHS Standard Contract…

Dr Demis Hassabis, Co-Founder and CEO of DeepMind, Speaks about AI in Healthcare

On 28 September 2017, I attended the Annual Institute of Global Health Innovation Lecture: Artificial General Intelligence and Healthcare, delivered by Dr Demis Hassabis, co-founder and CEO of Google DeepMind. Artificial intelligence is the science of making machines smart argued Dr Hassabis, so how can we make it improve the healthcare sector? Dr Hassabis then went on to describe the work that DeepMind was carrying out in healthcare in areas such as organising information, deep learning to support the reporting of medical images (such as scans and pathology slides), and biomedical science. Dr Hassabis also discussed the challenges of applying techniques such as reinforcement learning in healthcare. He concluded that artificial intelligence has great scope for improving healthcare; for example, by prioritising the tasks that clinicians had to carry out and by providing decision support aids for both patients and doctors. Dr Hassabis also discussed some of the ethical issues in using …

Patients are more satisfied with general practices managed by GP partners than those managed by companies

General practices in England are independent businesses that are contracted to provide primary care for specified populations. Most are owned by general practitioners, but many types of organisation are now eligible to deliver these services. In a study published in the Journal of the Royal Society of Medicine, we examined the association between patient experience and the contract type of general practices in England, distinguishing limited companies from other practices.

We analysed data from the English General Practice Patient Survey 2013–2014 (July to September 2013 and January to March 2014). Patients were eligible for inclusion in the survey if they had a valid National Health Service number, had been registered with a general practice for six months or more, and were aged 18 years or over. All general practices in England with eligible patients were included in the survey (n = 8017).

Patients registered to general practices owned by limited companies reported worse experience…