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Exploring the relationship between general practice characteristics, and attendance at walk-in centres, minor injury units and emergency departments in England 2012/2013: A cross-sectional study

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Original languageEnglish
Pages (from-to)702-708
Number of pages7
JournalEmergency Medicine Journal
Issue number10
Early online date17 Jun 2016
DateAccepted/In press - 14 May 2016
DateE-pub ahead of print - 17 Jun 2016
DatePublished (current) - Oct 2016


For several years, emergency departments (ED) in the UK National Health Service have faced considerable increases in attendance rates. Walk-in Centres (WiC), Minor Injuries Units (MIU) have been suggested as solutions. We aimed to investigate associations between practice and practice population characteristics with ED attendance rates or combined ED/WiC/MIU attendance, and associations between WiC/MIU, and ED attendance.
We used general practice-level data including 7,462 English practices in 2012/13, and present adjusted regression coefficients from linear multivariable analysis for relationships between patients’ emergency attendance rates and practice characteristics.
Every percentage-point increase in patients reporting inability to make an appointment was associated with an increase in emergency attendance by 0.36 (95%CI 0.06, 0.66) per 1,000 population. Percentage-point increases in patients unable to speak to a GP/nurse within 2 workdays and patients able to speak often to their preferred GP were associated with increased emergency attendance/1,000 population by 0.23 (95%CI 0.05, 0.42) and 0.10 (95%CI 0.00, 0.19) respectively. Practices in areas encompassing several towns (conurbations) had higher attendance than rural practices, as did practices with more non-UK-qualified GPs. Practice population characteristics associated with increased emergency attendance included higher unemployment rates, higher percentage of UK-whites, and lower male life-expectancy, which showed stronger associations than practice characteristics. Furthermore, higher MIU or WiC attendance rates were associated with lower ED attendance rates.
Improving availability of appointments and opportunities to speak a GP/nurse at short notice might reduce ED attendance. Establishing MIUs and WiCs might also reduce ED attendance.

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    Rights statement: This is the author accepted manuscript (AAM). The final published version (version of record) is available online via BMJ Publishing Group at Please refer to any applicable terms of use of the publisher.

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