FactCheck: Do people know their A&E staff better than their GPs?
“In fact, we’ve got to a point where A&E staff know some patients better than their own GPs.”
Health Secretary Jeremy Hunt, The Daily Telegraph, 10 September 2013
Mr Hunt has repeatedly blamed the crisis in A&E departments on the change in GPs’ out of hours arrangements brought in by Labour in 2003-04 and on the problems people have in procuring speedy appointments with their GPs.
“Since the last government’s misguided changes to the GP contract, it’s become easier to go to A&E and harder to go and see a GP,” he wrote in the Telegraph.
So easy in fact, that people know their local A&E staff better than their own GPs, he claimed.
His comments drew the wrath of Clare Gerada, chair of the Royal College of GPs, who said there was “blatantly no evidence” of this.
There is no doubt that A&E departments are under pressure, but are they shouldering GPs’ work? FactCheck dons its white coat.
The GP Patient Survey for July 2012 – March 2013 found that more than three quarters of patients were able to see or speak to someone on the day they wanted to.
The survey, carried out by Ipsos Mori on behalf of NHS England, found that 86 per cent of 965,799 patients surveyed were able to see or speak to someone on the day they wanted an appointment last year.
Of those patients who got an appointment, 77 per cent secured an appointment to see a GP at the surgery – the rest were given appointments with nurses or spoke to GPs or nurses over the phone, or arranged home visits.
Of the patients unable to get an appointment on the day, two in five took an alternative appointment date offered to them.
Crucially, only 9 per cent of them resorted to a walk-in centre or to an A&E department as an alternative.
GPs also got a good write-up from patients, with 93 per cent agreeing that they have trust and confidence in their GPs.
Mr Hunt however went on to tell BBC News that he wasn’t making a “generalised assertion” about all patients – but was referring to old people.
“For some patients, the problem we have is – particularly the frail elderly patient…they are going to A&E departments a lot when they would be much better cared for by their GPs,” he said.
We all know Britain’s elderly population is on the rise – the number of people aged over 80 is expected to double between 2010 and 2030, according to the British Journal of General Practice.
But Nigel Edwards, senior fellow at the King’s Fund think-tank, told FactCheck that this trend was well-flagged – and did not suddenly become a problem in 2004.
“It’s been increasing for at least 20 years – there has been no sudden magical event,” he said.
Mr Edwards said that it is the case that elderly people need more care, adding that “hospital is not necessarily a bad place for them”.
However, he added: “It is still the case that the bulk of the care is done by the GPs.”
A recent poll by the Royal College of GPs found that 55 per cent of GPs conduct around 40-60 consultations a day.
The average person is likely to see their GP between five and six times a year – while those aged 80 or over see their GPs between 12 and 14 times a year.
Latest available statistics from the Health and Social Care Information Service show that GPs conduct 303m consultations a year in England. HSICS estimated that this accounted for 90 per cent of all NHS contact.
Meanwhile, there were 21.7m A&E attendances in England last year, according to NHS data.
Mr Edwards’ colleague, chief economist John Appleby points out that in 2003-04 – when the large increase that Mr Hunt talks about began in A&E attendances – there was a change in the way the data was collated.
Until 2003-04, statistics on emergency department attendances only included “major units”.
But around this time, he writes, smaller units – including walk-in centres and minor injuries units – were introduced.
He told FactCheck: “Essentially they uncovered a need that wasn’t being dealt with – it’s like if you open up another lane on the motorway, it will fill with traffic”.
Yes, some of these people may have decided to use minor injuries units instead of their GPs, but he said it was “hard to believe” that the rise in A&E use is all down to this.
The Department for Health could offer no statistics to back up Mr Hunt’s claim – whether he was generalising, or just talking about old people.
FactCheck thinks perhaps he was generalising about old people.
On a national level however, the latest GP Patient Survey shows that 86 per cent of people get an appointment with their GP on the day they wanted one.
And of those that don’t get an appointment, only 9 per cent resort to A&E instead.
GPs are handling more than 300m appointments a year, while A&E departments in England last year took on 21.7m attendances.
As John Appleby from the Kings Fund told FactCheck, these figures just show that Mr Hunt’s sweeping statement was “a silly thing to say”.
By Emma Thelwell