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Characteristics of general practices associated with emergency-department attendance rates: a cross-sectional study
  1. R Baker1,
  2. M J Bankart1,
  3. A Rashid2,
  4. J Banerjee3,
  5. S Conroy1,
  6. M Habiba4,
  7. R Hsu5,
  8. A Wilson6,
  9. S Agarwal1,
  10. J Camosso-Stefinovic1
  1. 1Department of Health Sciences, NIHR CLAHRC for LNR, University of Leicester, Leicester, UK
  2. 2Leicestershire County and Rutland PCT, Leicester, UK
  3. 3University Hospitals of Leicester NHS Trust and Acute Care Lead, NHS Leicester Leicestershire & Rutland, Leicester, UK
  4. 4Cancer Studies, University of Leicester, and Associate Medical Director, Leicestershire County and Rutland PCT, Leicester, UK
  5. 5Department of Medical and Social Care Education, University of Leicester, and Leicestershire County and Rutland PCT, Leicester, UK
  6. 6Department of Health Sciences, University of Leicester, Leicester, UK
  1. Correspondence to Professor Richard Baker, Department of Health Sciences, University of Leicester, 22–28 Princess Rd West, Leicester LE1 6TP, UK; rb14{at}


Background Strategies are needed to contain emergency-department attendance. Quality of care in general practice might influence the use of emergency departments, including management of patients with chronic conditions and access to consultations.

Aim The aim was to determine whether emergency‐department attendance rates are lower for practices with higher quality and outcomes framework performance and lower for practices with better patient reported access.

Design A cross-sectional study.

Setting Two English primary-care trusts, Leicester City and Leicestershire County and Rutland, with 145 general practices.

Method Using data on attendances at emergency departments in 2006/2007 and 2007/2008, a practice attendance rate was calculated for each practice. In a hierarchical negative binomial regression model, practice population characteristics (deprivation, proportion of patients aged 65 or over, ethnicity, gender) and practice characteristics (total list size, distance from the emergency department, quality and outcomes framework points, and variables measuring satisfaction with access) were included as potential explanatory variables.

Results In both years, greater deprivation, shorter distance from the central emergency department, lower practice list size, white ethnicity and lower satisfaction with practice telephone access were associated with higher emergency-department attendance rates.

Conclusions Performance as indicated by the quality and outcomes framework did not predict rates of attendance at emergency departments, but satisfaction with telephone access did. Consideration should be given to improving access to some general practices to contain the use of emergency departments.

  • Primary care
  • emergency department
  • utilisation
  • general practice
  • quality of care

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  • Funding National Institute for Health Research. The views expressed in this paper do not necessarily reflect those of the NIHR or the Department of Health.

  • Competing interests (1) AR and MH are employees of Leicestershire County and Rutland Trust, and MH and JB are employees of University Hospitals of Leicester Trust that might have an interest in the submitted work in the previous 3 years; (2) AR's spouse is an employee of Leicestershire County and Rutland Trust; and (3) RB, MJB, SC, RH, AW, SA and JC‐S have no non-financial interests that may be relevant to the submitted work.

  • Provenance and peer review Not commissioned; externally peer reviewed.