One of the strands of Greater Manchester's Healthier Together programme aims to tackle A&E attendance at the edges of core primary care hours. The problem is that the approach is flawed.
As the HSJ reports, A&E departments see a spike in attendance for minor illness between 7pm and 10pm. This is just after GP surgeries close. So the theory is that by opening for longer hours, primary care can deal with these illnesses, reducing A&E demand.
The theory is right, the solution is wrong.
I am not saying that opening longer hours will not reduce minor illness attendance at A&Es. It may well do. Clearly, if you are ill you would rather attend a local surgery than a distant A&E.
What I am saying is that it will not reduce system costs. System costs are determined by number of points of healthcare delivery and capacity and access of those points. By increasing capacity and access, you do not reduce costs.
In addition, you will stimulate latent demand. With all illnesses, there is a level of uncertainty as to whether the illness is serious or can be ridden out. If the cost of allaying that uncertainty is a 4 hour A&E wait and a long round trip, the risk of bad illness has to be high - and so many people are currently not attending A&E because of this cost. Reduce the cost, and see increases in attendance.
What is more, other problems get exacerbated. People who would never attend A&E, will take up the cheaper access. The athlete foot that does not go away - let's sort it out with the GP after work, rather than going direct to a pharmacy. That cough that is a bit irritating - best understand what it is.
Lastly, it is not sustainable. A couple of years down the road the NHS figures out that costs have increased (for the reasons outlined above) and decides to cut costs by reducing these enhanced services. This results in a further increase in A&E attendance. That takes a couple of years to understand and another region goes- let's try what Manchester tried.
All of this sound far fetched? I would encourage you to look at what happened in London's Polyclinics and Walk-In centres; and at what is happening to London's A&E attendance.
