Demand for urgent care in England continues to rise with increasing numbers of attendances at emergency departments, and the associated growth in unplanned hospital admissions and healthcare costs. With NHS budgets under severe pressure, using emergency services appropriately will be important in an era of financial austerity in healthcare.Estimates of patients attending with conditions deemed non-urgent or inappropriate for accident and emergency services vary widely, from 6 to 80%. Previous research suggests that general practitioners (GPs) working in emergency departments can reduce referral rates, diagnostic testing, the proportion of patients who become emergency hospital admissions, and inappropriate attendances. However, little of this previous research is recent (much of it was published nearly 20 years ago) and new models of care for GPs working in and alongside emergency departments have now been developed, which remain to be evaluated.
In a paper published in JRSM Short Reports, Shamini Gnani and colleagues describe the methodology for the evaluation of an integrated urgent care model, which was commissioned by NHS Hammersmith and Fulham in 2009 to manage the rising number of urgent attendances at local hospitals. The evaluation includes an examination of the effect of the new model of care on outcomes such as utilization of diagnostic tests and effect on unplanned hospital admissions.
If the new model of care is shown to be both clinically effective and cost-effective, the model and the proposed plan of evaluation will also be helpful to other areas in England that are considering the introduction of similar models of GP-led urgent care to relieve pressure on hospital emergency departments.
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