Patients of GP practices that remain directly responsible for out of hours primary care may attend accident and emergency more often than others, analysis suggests. However, the research also indicates they may be admitted to hospital as an emergency less regularly.

Health secretary Jeremy Hunt last week repeated his view that changes to the GP contract introduced in 2004, which allowed practices to opt out of direct responsibility for out of hours care, were a mistake, and had contributed to rising demand for emergency hospital services.

HSJ compared the average emergency attendance rate for the minority of practices that have opted to remain directly responsible for out of hours care under their contract, to those that have opted out.

The average rate of attendances for the 407 opted-in practices for which information was available was 370 per 1,000 population, weighted for need.

For the 7,600 opted-out practices the figure was 285 per 1,000.

The average rate among those opting in was therefore 30 per cent higher than those opting out. The figures are from 2010, the most recent available.

However, the average rate of emergency admissions − another indicator of how well patients’ conditions are managed by primary care − was lower for practices that opted in. The average for opted-in practices was 83 per 1,000 weighted patients. For opted-out it was 87.

Emergency demand is affected by factors including the characteristics of a practice’s population, location and other local services.

NHS Alliance chief executive Rick Stern said the figures supported the view that contractual responsibility was not a major factor in demand. He said: “There are so many other variables. Whether you are opted in or opted out is not the most significant driver. Key things in demand include how close you are to the A&E, and continuity of [GP] care.”

Mr Hunt, speaking at a King’s Fund conference on primary care last week, said the 2004 contract changes were a “historic mistake” because they “abolished personal responsibility by GPs for patients on their lists”.

He is not expected to mandate that practices take back out of hours responsibility, but indicated he would use the GP contract to encourage them to reconsider arrangements for their patients. He said there “may be larger practices which will want to take back responsibility”, while smaller ones could make changes through their clinical commissioning group. Mr Hunt said he wanted to overhaul out of hospital services, beginning with “vulnerable older people”, and that changes could see practices “allocated” district nurses to work with them for given hours.

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Patients of GP practices which remain directly responsible for out of hours primary care may attend accident and emergency more often than others, analysis suggests.

However, it also suggests their patients may be admitted to hospital as an emergency less often.

Health secretary Jeremy Hunt last week repeated his view that changes to the GP contract introduced in 2004, which allowed practices to opt-out of direct responsibility for out of hours care, were a mistake, and have contributed to emergency hospital services demand.

HSJ compared the average emergency attendance rate of practices which remain opted-in to direct responsibility for out of hours care under their contract, compared to those which have opted-out.

The average rate of attendances for the 407 opted-in practices for which information was available was 370 per 1,000 population, weighted for need.

For the 7,600 opted-out, the figure was 285 per 1,000.

The average rate among those opted-in was therefore 30 per cent higher than those opted out. The figures are from 2010, the most recent available. Practices with very small populations were excluded from the calculation.

However, the average rate of emergency admissions – another indicator of how well patients’ conditions are managed in the community – was lower for practices which are opted-in. The average for opted-in practices was 83 per 1,000 weighted patients. For opted-out it was 87.

Emergency demand is likely to be affected by the type of practice’s populations. The average index of multiple deprivation of practices’ populations is 26 for those opted-in and 24 for those opted out.

The crude analysis’ findings appear to support the argument made by several healthcare leaders in recent months, that the contracting of out of hours is not a major factor in major A&E attendance and emergency demand.

Mr Hunt is currently running a consultation on making changes to out of hospital care for “vulnerable older people”, and has proposed that more GP practices take back responsibility for out of hours care.

He is not expected to impose this, but last week indicated he wanted to change the GP contract to encourage them to reconsider out-of-hours arrangements.  He said there “may be larger practices which will want to take back responsibility”, while smaller ones could act through their clinical commissioning group. Mr Hunt, speaking at the King’s Fund’s conference on improving primary care, said changes may also see practices “allocated” the time of district nurses to work with them.

Changes to the GP contract which are currently under negotiation are likely to require them to provide an additional level of service for a cohort of older patients from April.

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