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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.

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