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GPs could save the health budget $1.5 billion by stopping lower urgency cases flooding emergency
Lower urgency cases are filling up hospital emergency departments around the nation. Could GPs solve the problem?
Is there a better way to go for lower urgency cases?
New Australian Institute of Health and Welfare (AIHW) data shows 37% – almost three million – of the nation’s eight million emergency department (ED) presentations are considered ‘lower urgency.’
That means they could most likely be treated by a GP at a fraction of the cost of hospital treatment, making major inroads into the $4.9 billion annual cost of ED presentations.
The data follows a recent study estimating between 20% and 40% of ED presentations in Western Australia could be treated by GPs.
The AIHW data shows an increase in patients attending EDs for lower urgency issues during daytime hours when general practices are open, boosting the RACGP’s stance that GPs are ideally placed to tackle lower-urgency cases, which can often overwhelm EDs.
Lower urgency is defined as when a patient does not arrive by ambulance, is assessed as needing semi-urgent or non-urgent care and is discharged without referral to another hospital.
The RACGP has long stated that better support for and use of general practice would help to reduce avoidable emergency department presentations.
Over the last three years, in-hours lower urgency ED presentations rose from 60.5 to 61.1 per 1000 people, while after-hours cases fell from 58 to 56 cases per 1000.
Rates of lower urgency ED presentations are markedly higher in regional areas, at 159 cases per 1000 people, compared to 92 in the cities.
Children aged under 15 were 1.6 times more likely to come to emergency for issues considered lower urgency than the wider population, with 181 cases per 1000 people compared to 117 nationally, while older people were less likely to present with lower urgency issues.
GPs are skilled at managing issues such as injuries, wound care and acute infections that could otherwise lead to patients attending an ED.
Each non-admitted ED presentation costs the taxpayer around $533.
State governments in South Australia and Western Australia have made recent moves to slash the number of lower urgency cases by making better use of GP skillsets and availability in a bid to tackle chronic overcrowding and strain on EDs.
Other states are also grappling with overcrowded EDs, with New South Wales overcrowding forcing more than a third of patients with imminently life-threatening conditions to wait longer than recommended for treatment, while two Tasmanian hospitals were recently ranked the worst in the nation for overcrowding and ambulance ramping by the Australasian College for Emergency Medicine.
A body of Australian and international evidence shows better support for and use of GPs is associated with lower emergency visits and hospital use, decreased re-admissions, health benefits for Aboriginal and Torres Strait Islander peoples and reduced costs to the healthcare system.
Studies have also shown that patients who have continuity of care with a regular GP have lower rates of hospital and ED attendances, and lower risk of mortality.
In 2016–17, all Australian health spending by governments totalled $124.1 billion, of which only $9.1 billion went to general practice. That represents 7.4% of total health expenditure.
The RACGP’s Vision for general practice and a sustainable healthcare system, which is currently under review, documents the substantial savings across the healthcare system that could be achieved through better use of general practices.
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