“NHS England said there are 18 million GP appointments and 2.1 million A&E visits for self-treatable conditions a year at a cost of £850 million to the NHS.”
Daily Mirror, 12 February 2018 (p.5 of print edition)
“There are 18 million GP appointments and 2.1 million visits to A&E every year for conditions that could be dealt with at home, costing £850 million.”
The Times, 12 February 2018
These numbers were widely reported last week, but they’re quite rough and should be treated with some caution.
We can’t comment on NHS England’s medical advice, but we can say that the estimated cost savings are based on limited evidence.
We only have official estimates for how many GP appointments there were in total across England in 2008, and the proportion of these that are avoidable is based on a survey of GPs that may not be representative.
2.1 million attendances at A&E in 2016/17 resulted in no treatment being given, but we don’t know if this means they could have been self-treated. NHS Digital—which publishes the figures—says it has no data on how many patients had a self-treatable ailment.
The uncertainty around these figures also means that the estimate of their cost is very rough.
So what is it all about?
NHS England and Public Health England have launched a campaign which encourages patients to seek advice from a pharmacist when they have a minor ailment, instead of going to a GP or accident and emergency. The campaign is particularly aimed at parents and their children.
NHS England estimates that this could “help free up GP time for sicker patients and help save the NHS around £850 million each year as well as save time for busy families”, and provide patients with more convenient, timely advice, according to a press release provided to Full Fact.
Could 18 million GP appointments have been dealt with at home or at a pharmacy?
There were estimated to be around 300 million GP appointments across England in 2008—the latest official figures we have.
A report by the Primary Care Foundation and the NHS Alliance found that 6% of GP appointments in a 2015 study could have been avoided by patients going to the pharmacy instead (roughly 2%), or caring for themselves without clinical advice (roughly 4%). This would be around 18 million of the 300 million appointments.
But that figure is quite rough. It’s based on just under 60 GPs self-reporting how many patient consultations they thought could have been avoided, covering around 5,000 appointments altogether. There’s no evidence that these GP appointments were representative of the wider GP sector as a whole, nor that the they were intended to be representative. There was also a lot of variation in the proportion of appointments that different GPs thought were avoidable.
The number of GP appointments is also likely to have increased a lot in the last ten years, according to expert estimates. However, they also say it’s hard to know for certain.
Were 2.1 million A&E visits “self-treatable”?
NHS England says that 2.1 million visits to A&E were “self-treatable” in 2016/17, and told us that this referred to the number of attendances where patients were given no treatment after arriving at A&E in England.
NHS Digital—which publishes the figures—told us it didn’t have any figures on whether or not an A&E attendance could have been managed through self-care.
How much do avoidable appointments cost?
NHS England said that fewer avoidable appointments will free up GP time for sicker patients, and help to save money.
Research done by experts at the University of Kent, for NHS England and the Department of Health, found that the average cost of a GP consultation in England in 2016/17 was £31. Based on this, NHS England estimates that the 18 million self-treatable appointments in 2016/17 cost around £560 million. But the uncertainty around the number of avoidable appointments in the first place also makes this figure problematic.
The average cost to the NHS in England of someone attending A&E was £148 in 2016/17, according to figures from NHS Improvement. This, multiplied by the number of A&E appointments that year where no guidance was given, comes to £310 million. This assumes this type of A&E attendance costs the same as the average.
The Nuffield Trust also told us that reducing the number of GP and A&E visits might not lead to significant cost reductions. The average cost of an appointment factors in paying staff and occupying the premises, so fewer appointments won’t lead to financial savings unless resources such as the number of staff or buildings used to provide them can be reduced too.