Primary care factors associated with utilization of unscheduled secondary care

Unscheduled care is care that is delivered when the person seeking care and their health-care professionals, did not anticipate that care would be required. Reducing unscheduled care in hospitals (i.e. accident and emergency department (ED) visits and hospital admission) is a priority for the NHS. There is some research that has explored which characteristics of general practice may be associated with unscheduled secondary care use but no-one has systematically reviewed this work. Secondly, there is a lot of variation across practices in use of unscheduled secondary care services and the reasons for these differences are poorly understood.

The aim of this study is to evaluate how the organisation and delivery of primary care impacts on utilisation of unscheduled hospital care.

Firstly, our study includes a systematic review. This involves systematically looking for, and then summarising, the existing research evidence about the possible links between features of primary care and utilisation of unscheduled hospital care.

Secondly, we will look in depth, using a method called case studies, at 6-8 general practices that have high or low rates of utilisation of unscheduled hospital care. These practices will be from three different areas in England. We will use a combination of interview, observation and written materials to identify additional characteristics of practices that are associated with utilisation of unscheduled care. Finally, we will conduct a cross-sectional study with a much larger group of at least 320 practices. Using surveys and NHS data, we will look at the association between all the factors we have identified and ED use and emergency admissions across the three geographic areas.

This project will inform both future research and new interventions to reduce unscheduled secondary care utilisation, focusing on primary care factors. We will seek ethics approval for the study. The team includes GPs and researchers with experience in the methods and in unscheduled care.

For more information contact Dr Sarah Purdy.