Almost one million patients a year are seeking care at an A&E unit because they are unable to get a GP appointment, an analysis of NHS research has found.
The findings have prompted fresh concern that poor access to family doctors is a key factor behind the serious difficulties emergency departments are facing in coping with a continuing rise in arrivals.
The findings were released as a report showed that the proportion of total NHS spending committed to GPs, walk-in centres, optometrists and dentists fell from 29% to 23% between 2003-4 and 2012-13.
Margaret Hodge, the chair of the public accounts committee, which compiled the report, said the figures raise many questions over decisions made in Whitehall and their impact on the NHS as a whole. “It is deeply concerning that the proportion of total funding devoted to primary care has fallen, even though primary care is vital for tackling health inequalities,” she said.
There is also concern that a new strain of flu, which the winter flu vaccine does not specifically protect against, could also increase the pressures on hospitals.
NHS England’s latest survey of patients’ satisfaction with GP services shows that the proportion of unwell people who are unable to get a GP consultation had risen from 8.85% in 2011 to 10.91% last year. Of those almost one in 10 then decided to go to A&E.
Analysis by the Labour party said that by extrapolating the figures to the population of England as a whole, an estimated 941,646 patients headed to A&E between January and September 2014 because of their difficulty in accessing a GP. That contrasted with 652,094 who are likely to have taken the same action in 2011.
Andy Burnham, shadow health secretary, said the prime minister had helped create unprecedented strain on A&Es by scrapping patients’ right to see a GP within 48 hours.
He said: “David Cameron talks about the increase in A&E attendances as if it’s nothing to do with him, but these figures show he should take responsibility for driving people to A&E. He’s made it harder to get a GP appointment and it’s getting worse, contributing to the current crisis in A&E.”
The rising demand for care has already forced 15 hospitals in England to declare a major incident, cancel operations, call in extra staff and open extra wards to cope with the sheer number of patients.
But a government spokesman derided Labour’s figures as “yet another wilful attempt to distract from the fact that their botched 2004 GP contract destroyed the doctor-patient relationship and made it much harder to access care out of hours. That’s a real source of pressure on A&E, and one we’re sorting out by introducing evening and weekend GP access for 10 million people.”
Responding to the report, Dr Richard Vautrey, deputy chair of the British Medical Association’s GP committee, said that general practice was carrying out 340m consultations a year but underinvestment was having a major impact on GPs’ ability to cope with rising demand.
“The report rightly highlights the fact investment in general practice has been falling, while at the same time patient demand has skyrocketed.
“We cannot continue to meet rising demand with falling investment. General practice is already stretched close to breaking point so we need to address this as a matter of urgency,” he said.
The all-party committee of MPs was told by NHS England that primary care is expected to have more impact than clinical commissioning group spending on reducing inequalities.
“However, between 2003-04 and 2012-13, the proportion of total spending committed to primary care fell from 29% to 23% as a consequence of the NHS prioritising hospital initiatives such as reducing waiting times,” it said.
NHS England said the trend was the consequence of focusing resources on hospitals to reduce waiting times, but told the committee it would reverse the decline in future.
Dr Ben Marshall warned about the new strain of flu. A respiratory medicine specialist at Southampton General Hospital, he said that the number of patients being admitted as medical emergencies because of serious breathing problems had doubled from 25 or 30 to over 50 a day.
Tests showed that about half of them had a mutated strain of the AH3N2 strain of flu that has been the main type of flu that has been circulating this winter.
However, Dr Richard Pebody, the acting head of respiratory diseases at Public Health England, said that although the new strain could become the most dominant strain before this winter’s flu season ends, as it already has in the United States, the seasonal flu vaccine should offer “some protection” against it.
