Study summary

Pressure continues to grow on Emergency Departments (EDs) in the United Kingdom, with declining performance and adverse effects on patient outcome, safety and experience.

One proposed solution is to locate GPs in or alongside the ED, with a number of models introduced. Currently, 40% of EDs report primary care co-location, however evidence of effectiveness is weak. There is no consensus regarding the most efficient model of care, or even whether GPs should be employed in this way.

This mixed-methods study will ask:

• What is the impact of GPs working in or alongside the ED (GPED) on patient care, the primary care and acute hospital team and the wider urgent care system?
• What is the differential impact of alternative service models of GPED?

The study will be structured around three work packages:

Work Package A: Mapping, taxonomy and interviews

We will map, describe and classify current models of GPED in all EDs in England, building on previous work. This will include details of the service model and the date of any service change. Through interviews with key informants we will examine the hypotheses that underpin GPED and its anticipated benefits.

Work Package B: Quantitative analysis of national data

We will measure the impact of the models of GPED identified in Work Package A, compared to a no-GPED model, using a retrospective analysis of routinely available Hospital Episode Statistics (HES) data. Our primary outcome measure is the number of ED attendances, and we will also assess a wide range of secondary outcomes.

We will also calculate costs and consequences of the different GPED models on the basis of their estimated effects alongside estimated resource use, with the objective of identifying genuine changes in resource utilisation.

Work Package C: Case studies

We will complete a detailed mixed-methods analysis in ten case study sites that are about to implement (six sites), or have already implemented (four sites) a GPED model of care. These sites will be purposively selected to represent a range of geographical locations and two or three leading models of care based on the telephone interviews conducted in Work Package A.

The six prospective case study sites will be complemented by a further four case study sites selected to include well-established GPED models, to understand how services mature and develop over time.

Data collection in the case study sites will include:

• ED data, combined with local data sources relating to the wider urgent care system, including primary care data, where available.
• Non-participant observation of clinical practice.
• Patient and carer interviews

Benefits of the research

We will disseminate a comprehensive assessment of GPED from multiple perspectives to identify the most efficient model of care, maximise clinical and cost effectiveness, reduce staff pressure and improve patient outcome, safety and experience in the UK and internationally.

Funding

This research is independent research funded by the National Institute for Health Research (Health Services and Delivery Research, 15/145/06 – General Practitioners and Emergency Departments (GPED): Efficient Models of Care). The views expressed in this website are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health.

Contact us

For any questions about the study please contact Dr Heather Brant, Project Manager: heather2.brant@uwe.ac.uk