Cost effectiveness of GP's within an ED may not be generalisable everywhere
The authors of the recent study looking at the addition of a GP within an Emergency Department are to be congratulated for their research into a difficult area . I would have to challenge the authors conclusions that the addition of another body i.e. a GP would have only a limited effect on patient process time compared to usual care. From the staffing figures provided they are increasing clinician numbers from 3 to 4 which is a significant 33% increase, more if they had a GP registrar as well. In addition they are creating a seperate "fast track scheme" that has previously demonstrated significant benefits in reducing waiting times . Secondly the cost effectiveness of general practitioners will vary dependant on the cost of employing the GP's and their prodcutivity. The scheme I was involved with the cost of the GP's for covering weekday shifts in the ED worked out at around 90 pounds/hour. This is more than the cost of a Specialist in Emergency Medicine who is able to see a wider range of conditions presenting to the ED. I am not against closer integration of Emergency care as a wider range of skills offered will mean it is more likely a patient will be treated by a clinician best trained to treat them, rather than the situation of discrete urgent care providers that currently compete in some areas and also allow patients to shop around different providers only increasing the utilisation of scarce healthcare resources. However it must be realised that not every situation is the same and some solutions though may improve patient care may not necessarily reduce costs.
1. Judith E Bosmans, A Joan Boeke, Marguerite E van Randwijck-Jacobze et al. Addition of a general practitioner to the accident and emergency department: a cost-effective innovation in emergency care.Emerg. Med. J. 2011 0:emj.2010.101949v1-emj.2010.101949
2. M Cooke, S Wilson, and S Pearson. The effect of a separate stream for minor injuries on accident and emergency department waiting times. Emerg Med J. 2002 January; 19(1): 28-30.
Conflict of Interest:
I have previously been involved with a scheme to integrate GP's within a UK Emergency Department