I was reading a BBC article from 2 days ago about the increased waiting times in Accident & Emergency (A+E) departments in England, The article highlights that the lack of access to GPs has been raised as a contributor and the controversial government plans for £250m funding for GP surgeries to see more patients face-to-face. Needless to say, the comments received on the article are wide ranging.
What are the headline numbers?
1. The number of patients having to wait more than 4 hours for admission, transfer or discharge has gone up again. In September 2021, around 25% of patients had to wait longer than 4 hours (compared to 16.4% two years ago in October 2019).
2. Once a decision has been made for a patient to be admitted to hospital, the amount of time they have to wait has gone up as well.
27% had to wait for more than 4 hours (compared to 19% in October 2019). 1.3% had to wait longer than 12 hours (compared to 0.2% in October 2019).
What are the underlying trends?
1. The number of attendances to A+Es dipped during the Covid-19 pandemic, but have now increased back up to pre-pandemic levels.
2. A+E accounts for a significant proportion of the emergency admissions to a hospital, with the percentage slightly higher than before the pandemic. These patients will present a different challenge to and requirement from the A+E workforce.
3. The total number of GP appointments over the last 6 months (in 2021) are largely comparable to the same 6 months before the pandemic started (in 2019), with an actual 0.8% increase in the number of appointments. If the number of Covid-19 vaccinations and associated appointments are considered, the number of appointments offered in 2021 has significantly increased (by 21%).
The major difference is the percentage of face-to-face appointments. These made up 77% in the above 6 months during the pre-pandemic period (in 2019), while it made up only between 53-57% during the last 6 months (in 2021).
When exploring the type of appointments and increasing the face-to-face appointments, it is worth considering the following 3 key elements.
First, the number of GPs. GP practices are independent organisations and it could be argued that GP partners are most invested and tied in with their success. Worryingly the number of GP partners have dropped by 1,124 FTE (6%) when comparing numbers in August 2021 with numbers before the pandemic started (in December 2019).
Second, the infection control requirements due to Covid-19 and the impact that has time taken on the ground – for example, for triage and taking the necessary precautions in between patients seen face-to-face.
Third, the impact of the type of appointments. It has been shown that non face-to-face appointment can increase GP workload by up to 25%. I wrote more about this here.
There is no easy answer, but whatever the solution, it needs to take into account all of the underlying drivers and issues – otherwise it’s just a waste of time, effort, and money …
Very happy to hear your comments below or feel free to email me to share ideas – janak@usehealthdata.com