Residents of England claim their health care is the best in the world - and some in America agree. While America clearly leads the world in medical treatment, everyone with the money from almost every country quickly abandons their health care for US shores, it is only burden-free for the rich and the poor. In between, many might not go to the doctor.

But in England plenty of people want to go to a doctor because it is free. They just can't get an appointment so they go to an emergency room which costs far more, which makes the burden on taxpayers even greater.

A new paper estimated that in 2012-2013 there were 5.77 million emergency room visits in England that were preceded by an inability to get a timely GP appointment - an increase of 11 percent (2.2 million attendances) between financial years 2008-2009 and 2012-2013. 

The scholars at Imperial College London estimated that 5.77 million emergency room visits represent 26.5 percent of emergency room visits during this time. Lead researcher, Thomas Cowling of Imperial College London said, "There has been a lot of talk in recent years about rising numbers of A&E attendances and the impact that this might be having on A&E departments. It has been suggested that a lack of access to GPs could be a factor but there hasn't been much evidence to back this up. The aim of this analysis was to inform the debate; until now, the numerical scale of the problem hadn't been estimated."

They arrived at this figure using two basic steps. First they estimated the number of GP consultations for the financial year 2012 – 2013, based on estimates for previous years and the trend for this figure to increase over time. This provided an estimate of 345.6 million GP consultations for 2012-2013.

Next they used patients' own accounts of their experiences of their local GP practice, from the GP Patient Survey in 2012-2013, to calculate the ratio of attempts to obtain a GP appointment that resulted in A&E attendance to attempts that resulted in a GP consultation. The GP Patient Survey was answered by approximately 1 million patients from all eligible general practices in England. The ratio was calculated from answers to questions regarding people's last attempt to see or speak to a GP doctor or nurse.

This showed that for every 100 attempts that resulted in a GP consultation there were 1.67 attempts that resulted in visiting  emergency rooms . Although this ratio is small, the absolute effect when multiplied by the 345.6 million GP consultations that occurred in 2012-2013 provides a figure of 5.77 million  emergency room visits that were preceded by an inability to get a suitable appointment. This is 26.5 per cent of the unplanned emergency room visits (i.e. those that are not follow up appointments at A&E such as for removal of stitches).

The study provides a first snapshot of the situation but the researchers call for more research to understand what lies behind this figure, including an in-depth evaluation of a recent Department of Health pilot launched to combat this problem, in which 1,147 General Practices in England are offering appointments outside of current opening hours. An examination of the impact of this pilot could help ascertain whether convenient access to a GP appointment can prevent some emergency room visits..

"It may be tempting to make an automatic conclusion from the results that improving access to General Practices will solve the problem," said co-author, Professor Azeem Majeed from the School of Public Health, Imperial College London. "But the picture is fundamentally much more complicated than that. Firstly, it may be that the same patients would still go to A&E even if they did get better access to GPs. Secondly, if improving GP access does help, there is a need for more research to find out the best way to approach this. Thirdly, it is not currently clear if increasing numbers of A&E attendances do actually lessen performance in terms of increasing waiting times."

Thomas Cowling added: "Our research has provided a helpful indication of the situation, but we acknowledge the uncertainty present in the estimates. The approach we used was relatively straightforward and the only feasible way to get an overall national estimate that could inform policy in a timely manner. A more detailed picture could be obtained from a survey of a nationally representative sample of patients attending A&E. In addition, the benefits of increasing access to GPs could, and should, be assessed by evaluations of current pilots that aim to improve GP access."



 Published in the British Journal of General Practice. Source: Imperial College London