Background to the project

Despite many initiatives to reduce demand, pressure continues to grow on the UK’s Emergency Departments, with an associated decrease in performance. This leads to Emergency Department (ED) crowding, associated with adverse outcomes and increased mortality.

There is a clear need to find a solution that reduces the burden on EDs and improves patient experience and safety. The Keogh Review of urgent care (PDF) aims to reduce pressure on EDs by treating more patients close to home in primary and community settings, and is now being implemented in England. It includes a recommendation that co-located primary care models should be considered in every ED, however, the optimal model to achieve this has not yet been identified, and evidence for the effectiveness of GPs in the ED is weak in both the UK and Europe.

Nevertheless, there is an increasing trend to include GPs at the hospital front door. A joint report (PDF) from four Medical Royal Colleges recommended that every ED should have a co-located primary care facility. Estimates of the proportion of ED patients that could be managed by a GP vary widely between 15% and 40%.

There are a range of models of integration; most involve GP services alongside ED staff, with some operating a separate co-located service as a primary care “filter” in front of the ED, while others are more integrated with the ED team. Current evidence suggests that some form of co-location exists in 43% of EDs, but this is set to increase rapidly and co-location is a key aim of NHS England’s urgent and emergency care “Vanguard sites”.

In the Spring budget of 2017, delivered on 08 March, the Chancellor of the Exchequer announced the following:

"Experience has shown that onsite GP triage in A&E departments, can have a significant and positive impact on A&E waiting times. I am therefore making a further £100m of capital available immediately for up to 100 new triage projects at English hospitals in time for next winter."

As a direct result of this announcement, a significant number of EDs in England have bid for a share of this capital funding in order to implement GPED models of care before the winter of 2017/18, and are being supported by NHS England and NHS Improvement to make changes in the way their services are delivered.

An ideal research opportunity

This provides an ideal research opportunity, since it is essential that these and all GPED initiatives are based on the best available evidence, and that where adopted they are used to generate reliable research that will guide future policy.