Extended opening hours in general practice can lead to reductions in attendances to A&E settings, a study published in PLoS Med has found, although major commitments to the practice nursing workforce will be needed to benefit the public.
As part of the study, 56 practices in Manchester offered additional routine and urgent appointments during evenings and weekends in 2014. The appointments lasted 10 to 15 minutes and amounted to an average of 35 hours additional opening per week.
A total of 51,465 additional appointments were offered as part of the scheme, equating to 152 extra appointments per 1000 people registered over the year. There was a 26.4% relative reduction in ‘minor’ A&E visits, or 10,933 fewer visits, compared to areas where practices did not offer additional appointments.
‘There were practices with extended hours, and there was a decline in A&E attendance from what I gathered from some of the findings,’ said Kathryn Yates, professional lead for primary care at the Royal College of Nursing. ‘So obviously that’s having some local effect. Whether you could then replicate that on an England-wide level is subject to lots of issues associated with funding, having practitioners with the right skills in the right place and enabling practitioners who are skilled and competent to be able to deliver that service.’
Ms Yates suggested that to deliver the seven-day services, workforce planners would need to concentrate on ‘the three Rs: recruitment, retention and the return to general practice,’ to ensure that the workforce was equipped to provide the additional hours.
She also stated that extended hours would be largely unhelpful without improving patient education around the availability of services. ‘If you are providing an out of hours walk-in service by appointment or walk in, one of the crucial elements is how you enable people to think differently to not go to A&E,’ she added. ‘If people don’t know whether they should access it, then how do you enable people to think differently about their behaviours?’
The authors of the study shared Ms Yates’ view that while beneficial, workforce planners would need to ensure that primary care settings were supported to extend opening hours. ‘Extending opening hours in primary care may be a useful addition to policies aiming to reduce pressures on hospital services, potentially reducing patient-initiated use of the emergency department for minor problems – but at a significant cost,’ they commented.