Exploring the relationship between the quality and availability of primary care services and demand for emergency care. (360G-Wellcome-208183_Z_17_Z)

Despite the implementation of a number of programmes, crowded accident and emergency (A & E) departments and increasing unplanned hospital admissions are now two of the biggest challenges facing the NHS. There is currently a focus on policies to reduce A & E attendances through changes in primary care, despite limited evidence of a relationship between the availability and quality of primary care services and the demands placed on secondary care. The focus of this PhD is to utilise a newly available and underutilised administrative dataset of all A & E attendances in England to examine the relationship between the volume and composition of A & E attendances and the accessibility and quality of primary care services. Firstly we will develop methodology to identify A & E attendances which could be avoided with better quality primary care and attendances which would be more appropriately treated within a primary care setting. This will establish the extent of the problem and potential scope for interventions. Once we have identified the potential scope for interventions, we will assess where best to target interventions by analysing if, and how, factors of primary care services influence the demand for emergency care. Finally we will assess the potential cost-effectiveness of current interventions.