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The number of visits to hospital emergency departments (EDs) in England has increased by 20% since 2007-08, placing unsustainable pressure on the National Health Service (NHS). Some patients attend EDs because they are unable to access primary care services. This study examined the association between access to primary care and ED visits in England. A cross-sectional, population-based analysis of patients registered with 7,856 general practices in England was conducted, for the time period April 2010 to March 2011. The outcome measure was the number of self-referred discharged ED visits by the registered population of a general practice. The predictor variables were measures of patient-reported access to general practice services; these were entered into a negative binomial regression model with variables to control for the characteristics of patient populations, supply of general practitioners and travel times to health services. MAIN RESULT AND CONCLUSION: General practices providing more timely access to primary care had fewer self-referred discharged ED visits per registered patient (for the most accessible quintile of practices, RR = 0.898; P<0.001). Policy makers should consider improving timely access to primary care when developing plans to reduce ED utilisation.

In their paper on the effect of illness adjustment on regional mortality and spending rates using standard and visit corrected illness methods for adjustment, Wennberg and colleagues compare adjustment using diagnoses listed in administrative databases with additional adjustment for the frequency of doctors' visits. 1 They acknowledge that data on the use of healthcare cannot be used directly as a proxy for need or risk because these data also reflect differences in access to and supply of healthcare services. Previous research has developed several disease prevalence models for general practice populations and investigated the associations at practice level between diagnosed and undiagnosed disease prevalence, primary care quality and resourcing, and hospital utilisation. 3 4 5 This work has also shown that, despite almost universally accessible primary care services, prevalence of undiagnosed disease in the UK is often high, especially for diseases with insidious onset, such as chronic obstructive pulmonary disease and dementia. Association of population and primary healthcare factors with hospital admission rates for chronic obstructive pulmonary disease in England: national cross-sectional study.

The head to head debate on general practice opening hours does not specify the number of additional opening hours. 1 Similarly, the proposal for GPs in England to see patients from 8 am to 8 pm, seven days a week, tells us little about how much longer GPs would provide consultations. 2 We analysed NHS Choices data, obtained on 1 October 2013, on surgery (rather than reception) opening hours for 8973 general practices in England ( www.nhs.uk/ ). [...]does the government intend to increase the number of consultation hours each week, as well as extending surgery opening hours (for example, two GPs could provide two hours of consultation in one or two surgery opening hours)?

The current income limit is so low that adverse health impacts may occur in those with below average incomes. [...]prescriptions are initiated by doctors, so there is little justification for charging. 2 GPs and other practice staff have increased, but more slowly. 3 Accident and emergency attendances increased from 12.5...