News story

New models of out-of-hours GP care could reduce A&E attendances in England

Pressure on over-crowded A&E departments could be reduced if patients requiring out-of-hours urgent care were encouraged to see a GP based in or near the hospital first, according to Monitor.


The regulator believes the NHS may be able to reduce attendances at A&E and provide better services for patients if it was able to adapt aspects of the model of out-of-hours emergency care used successfully by the public health service in Holland.

This is one of the suggestions from an investigation into how other comparable health systems overseas are meeting the challenge of delivering higher quality care at lower cost.

After studying aspects of healthcare in 7 other countries, Monitor concluded that no other single comparable system offered a way to deliver consistently higher quality care at lower cost than the NHS across the board. The NHS was the least expensive with spending per head per year at $3,659, significantly lower than the average of $6,087 for the countries Monitor studied.

However, the report identified that there are 3 specific service models in use abroad that might be able to offer benefits if used more widely by the NHS:

  • patients who need urgent treatment at night or weekends first contacting an out-of-hours GP, based in a specialist clinic that is often co-located with an A&E department. Fewer than half the number of patients per thousand (around 120 per year) in the Netherlands attend A&E compared with England (around 278 per year). This already happens, for example, in Cambridgeshire where patients undergo a triage from a qualified nurse and can access out-of-hours GP services, some of which are co-located in A&E.

  • a 3-tier network of maternity care with more structured links between maternity and paediatric services and agreed protocols for transfers. Under this approach the lowest-risk mothers-to-be give birth close to home, while higher-risk patients are treated at more specialist units, for example with neonatal intensive care beds or facilities for premature babies. The NHS already uses this sort of “risk-tiering” approach in services like stroke and A&E, but the report says the NHS could learn from the experience of Stockholm in Sweden, and Ontario in Canada.

  • patients who have complex care needs, but live in rural areas, using technology such as video links to access highly specialist care from the kind of expert doctors that might not be available at their local hospital. This is happening in areas such as Surrey, where a telestroke service currently operates.

David Bennett, Chief Executive of Monitor, said:

The NHS is already delivering care in innovative ways but we need continually to be looking for examples of good care at home and abroad, and adopting them as fast as possible.

Implementing new models of care is central to the Five Year Forward View and this report sets out some practical examples of how other health systems are addressing similar challenges.

Professor Terence Stephenson, Chairman of the Academy of Medical Royal Colleges, said today:

The NHS is not alone in facing the challenges of delivering higher quality patient care at lower cost. The NHS is already delivering innovation, but Monitor’s report provides a welcome insight into how other comparable health systems abroad are meeting this challenge.

This is a useful contribution to the wider debate about how the NHS needs to change.

Read the full report: ‘Exploring international acute care models

Published 4 December 2014