Abstract
Ambulatory care sensitive conditions (ACSC) can be managed in primary care and high-quality care should reduce emergency hospital attendances (EHA) due to ACSC.
To identify general practice characteristics associated with different levels of EHA for ACSC.
Composite index analysis, including agglomerative hierarchical clustering. Data (2019) from the English general practice workforce minimum data set (wMDS), openly available practice indicators, and hospital-linked routine pseudonymised primary care records. Clustering was performed at practice level. Logistic regression, controlling for patient-level factors, explored if the odds of EHA differed across clusters.
Two clusters were identified. Cluster 1,
= 281 practices, 3 175 300 patients - the partnership training model, had: more practices with a GMS contract (70.1% versus 45.4%,
<0.001) and providing GP training (73.0% versus 38.0%
<0.001), partners accounting for a higher proportion of total GP FTE (63.4% versus 29.5%,
<0.001), fewer encounters per patient per year (10 versus 20), higher proportions of patients reporting good experiences (85.9% versus 79.2%, p<0.001). Cluster 2,
= 97 practices, 1 163 030 patients - the multiprofessional urban deprived model had: lower proportions of practice FTE performed by GPs (19.4% versus 23.9%,
<0.001), higher proportions of encounters delivered by other healthcare professionals (15.5% versus 5.7%,
<0.001), more urban practices (90.7% versus 80.0%,
<0.01, greater deprivation (
= 0.02). The odds of EHA in Cluster 1 was 11% lower than Cluster 2 (
<0.0001).
These findings have implications for policies about the partnership model, and current trends that encourage more encounters with a multiprofessional team.