Evaluation of winter pressures on general practice in Manchester: a cross-sectional analysis of nine GP practices.

Sinead Millwood,Jon Hopwood,Peter Tomlinson

doi:10.3399/bjgpopen20x101138

Sinead Millwood, Jon Hopwood + Show 1 more

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https://doi.org/10.3399/bjgpopen20x101138

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Abstract

BackgroundThe Nuffield Trust’s report on NHS winter pressures highlights a lack of data for primary care, with a consequential focus on secondary care. An increase in data is required on the scale of the winter demand on primary care, so the need for investment in this area can be clearly seen.AimTo quantify seasonal variation in workload in primary and secondary care.Design & settingAnalysis of data for nine GP practices in Greater Manchester with a patient population of 75 421.MethodDescriptive and comparative analyses were performed for winter and summer periods in 2018–2019. Data were obtained from the North of England Clinical Support Unit (NECSU) via the Rapid Actionable Insight Driving Reform (RAIDR) toolkit, and EMIS Enterprise clinical audit tools.ResultsAccident and emergency (A&E) attendances increased by 4% (P = 0.035) during winter with no difference in the number of hospital admissions (P = 0.668). The number of problems (defined as separate diagnoses or causes for a GP consultation, for example, chest infection or medication request) seen in general practice increased by 61% (P<0.001) in winter compared to summer, as did the number of GP consultations, which was also 61% (P<0.001). Respiratory diagnoses saw the greatest seasonal variation accounting for 10% in winter compared with 4% in summer (P<0.001). Self-referral accounted for 66% of all A&E attendance and increased by 16% in winter. GP referral accounted for 7% in winter and 6% in summer (P = 0.002).ConclusionGeneral practice observed a greater seasonal increase in presenting patients compared with secondary care. Any winter pressures strategy should target both respiratory illness and patients who self-refer to A&E. Transferring 50% of self-referrals in Manchester to GP appointments would achieve a £2.3 million cost saving. Increasing provision in primary care requires funding and increased appointments, but more importantly improved patient opportunities to easily access timely advice and assistance.

Highlights

Each winter the media reports on a lack of hospital beds, overflowing A&E departments, and queues of ambulances
Data were obtained from the North of England Clinical Support Unit (NECSU) via the Rapid Actionable Insight Driving Reform (RAIDR) toolkit, and EMIS Enterprise clinical audit tools
The number of problems seen in general practice increased by 61% (P

Summary

Introduction

Each winter the media reports on a lack of hospital beds, overflowing A&E departments, and queues of ambulances. There is an ongoing narrative regarding winter pressures on the NHS with a focus on secondary care and extra funding to assist hospitals and emergency departments during the winter months. The Nuffield Trust’s report on NHS winter pressures highlights a lack of data for primary care, with a consequential focus on secondary care.[1] The scale of the extra demand has not been well documented and without knowing this it is difficult to make an argument for winter pressures investment in general practice. Directing more towards general practice may reduce winter pressures on both primary and secondary care. The Nuffield Trust’s report on NHS winter pressures highlights a lack of data for primary care, with a consequential focus on secondary care. An increase in data is required on the scale of the winter demand on primary care, so the need for investment in this area can be clearly seen

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