The first ever large-scale research into attitudes to emergency care, carried out by the National Centre for Social Research, reveals that 86% of us think that too many people use A&E when they don’t need to. And with NHS England reporting the highest ever A&E attendance figures for July, the issue of high demand shows no sign of going away any time soon.
Some might ask why those responsible for health services should care about people’s attitudes towards different types of healthcare. Surely planning services should be a straightforward case of providing the most appropriate services for likely medical needs? In fact, we know from the wider literature that certain groups, like parents of young children and people living in the most deprived areas, make higher use of A&E than would be expected based on their levels of illness, and that some people use A&E when they don’t have an urgent medical problem, so it isn’t as simple as that.
Attitudes are part of the bigger picture and it makes sense to explore them as potential drivers of people’s decisions about which health service they use. Our research, funded by the National Institute for Health Research and in collaboration with the University of Sheffield, has undertaken an in-depth exploration of attitudes to emergency care as part of the British Social Attitudes survey carried out in 2018. We’re interested in whether particular attitudes are widespread among the public, and whether they are more likely to be held by particular groups who have been identified as being more likely to use emergency health services for non-urgent conditions.
The findings show some so-called ‘push’ factors that may mean people are put off from going to their GPs, while for small minorities there are ‘pull’ factors that make A&E attractive to them. Two key areas where we see this is in access to services, and confidence in doctors. Half of the British public say it’s hard to get a GP appointment – rising to two-thirds of parents with children under 5 years old. Recent data by Pulse shows that the average wait for a routine appointment is now over 2 weeks for the first time ever, and for a minority of GPs it’s as long as 3 or 4 weeks.
At the same time over a third (36%) say they prefer services where they don’t need to make an appointment. This view is held by nearly half (48%) of people living in the most deprived areas.
Either one of these perceptions may mean that people are not going to their GP with medical concerns – and of course, a non-urgent matter may become urgent if the person doesn’t get medical attention.
While only 11% overall say they do not have much confidence in their GP, the figure is twice as high among parents of children aged under 5 (20%) and also higher for those living in the most deprived area (18%). And while just 1 in 5 people (19%) say A&E doctors know more than GPs, the figure is higher among those in the most deprived areas (28%).
Taken together these attitudes suggest that on the one hand, some people may be reluctant to see their GP, while on the other hand, certain groups are more attracted to what A&E offers them. And these attitudes are more likely to be held by those groups who we know make higher use of A&E.
The fuller report also looks at people’s confidence in deciding whether to see a doctor, their awareness of NHS services, and how likely they are to use the internet for health advice – all of which raise questions about the different strategies to tackle the high demand for emergency healthcare. These findings will provide food for thought for policymakers and those involved in delivery of both primary healthcare and emergency health service provision. If demand for emergency services is to be managed, these findings suggest that the beliefs that some groups hold about A&E may need to be challenged, alongside improving access to GPs and raising awareness of alternative services.
The chapter is based on data collected as part of independent research funded by the National Institute for Health Research (Health Services and Delivery Research, 15/136/12 – Drivers of Demand for Emergency and Urgent Care (DEUCE)). The views expressed in the publication are those of the authors and not necessarily those of the NHS, NIHR or the Department of Health.