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Can a partnership between general practitioners and ambulance services reduce conveyance to emergency care?
  1. Manuel Villarreal1,
  2. Jonathan Leach2,
  3. Kandala Ngianga-Bakwin1,3,4,
  4. Jeremy Dale1
  1. 1 Warwick Medical School, University of Warwick, Coventry, UK
  2. 2 Davenal House Surgery, Birmingham Road, Bromsgrove, UK
  3. 3 Department of Mathematics, Physics and Electrical Engineering, Faculty of Engineering and Environment, Northumbria University, Newcastle upon Tyne, UK
  4. 4 Faculty of Health and Sports, University of Agder, Kristiansand, Norway
  1. Correspondence to Dr Jonathan Leach, Davenal House Surgery, Birmingham Road, Bromsgrove B61 ODD, UK; jonathan.leach{at}


Background Emergency services are facing increasing workload pressures, and new models of care are needed. We evaluate the impact of a service development involving a partnership between emergency ambulance crews and general practitioners (GPs) on reducing conveyance rates to the Hospital Emergency Department(ED) .

Methods The service model was implemented in the West Midlands of England. Call handlers identified patients with needs that could be addressed by a GP using locally agreed criteria. GPs supported the assessment of such patients either at scene or by telephone. Routine data were collected from October 2012 to November 2013, from the ambulance service computer-aided dispatch system. Logistic regression models were used to determine the likelihood for patients being transported to ED.

Results Of 23 395 emergency contacts during the evaluation period, 1903 (8.1 %) patients were triaged to GP supported assessment. Mean age (SD) was 61.8 (27.9) years; 42.9 % were aged 75 years and over. 1221 (64.2%) had face-to-face GP assessment and 682 (35.8%) via telephone. 1500 (78%) of those who received GP support were not transported to hospital. After controlling for confounders, those aged greater than 75 years (OR 0.67; 95% CI 0.52 to 0.86), and females (OR 0.64; 95% CI 0.51 to 0.82) were less likely to be transported, while those who received GP telephone input rather than face-to-face assessment were more likely to be transferred to an ED (OR 2.14; 95% CI 1.69 to 2.72).

Conclusion Support of the paramedic service by GPs enabled patients to avoid transfer to an ED, potentially avoiding subsequent hospital admission, reducing costs and improving quality of care for patients that are not in need of hospital services. However, use of services in the days following the call was not assessed, and hence the overall impact and safety requires further evaluation.

  • General Practice
  • Ambulance service
  • urgent care
  • pre-hospital
  • admission

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  • Funding NIHR In-Practice Fellowship partially funded the research work of MV.

  • Competing interests JL was the former medical director for NHS Worcestershire and received remuneration from WMAS. MV worked with the GP WMAS scheme.

  • Correction notice This paper has been amended since it was published Online First. Owing to a scripting error, some of the publisher names in the references were replaced with ’BMJ Publishing Group’. This only affected the full text version, not the PDF. We have since corrected these errors and the correct publishers have been inserted into the references.