GP out-of-hours and pay reforms linked to more emergency admissions for children

Government reforms of GP working practices in 2004 were associated with a rise in potentially avoidable emergency admissions for children.

The reforms altered GP contractual hours, allowing GPs to opt out of providing care out of surgery hours. A financially incentivised scheme aimed at improving quality of care provided mainly to adults was also introduced, which possibly detracted focused care from children.

A study published today in Annals of Family Medicine, funded by the National Institute for Health Research, found that the GP contract was associated with an eight per cent increase in short stay admissions for potentially avoidable chronic conditions.

Researchers from Imperial College London studied trends in 7.8 million unplanned admissions from 2000 to 2012. Over half were short stay admissions for potentially avoidable infectious and chronic conditions.

The number of children who were admitted to hospital with chronic conditions such as asthma and diabetes increased by 8,500 a year immediately after the policy changes. The reforms were not associated with an increase in admissions for potentially avoidable infectious diseases, which were increasing long before the incentive schemes.

Dr Sonia Saxena, a practising GP and lead author of the study from the School of Public Health at Imperial College London, said: “Chronic conditions in children require good quality management in primary care and are sensitive to changes in GP working patterns. Avoidable admissions can be detrimental to the child, inconvenient to their families and expensive for the NHS.

“GPs have worked hard to achieve significant health gains in adults as a result of these policies. Now we have clear evidence that the unintended consequences have been that children whose care was not prioritised have had to turn to the emergency services, which in many cases results in poorer health outcomes in children and waste in the health system.”

Emergency admissions have been rising for more than a decade. The rise is driven by short stay admissions, those of less than two days, which are potentially preventable with good care in the community.

Access to GP appointments has been a heated topic in the general election. The Conservatives promised access to appointments from 8am to 8pm, seven days a week. A recent British Medical Journal article by Imperial researchers concluded that pledges about improving access to GPs would be challenging to achieve. 

Reference: E. Cecil et al. ‘Impact of UK primary care policy reforms on short stay unplanned hospital admissions for children with primary care sensitive conditions: interrupted time series analysis.’ Ann Fam Med 2015;13:214-220. doi: 10.1370/afm.1786.

See the press release of this article