UK Primary Care Reforms Resulted In More Unplanned Hospital Admissions For Children Interview with:
Elizabeth Cecil, MSc
Department of Primary Care and Public,
Health, Imperial College London
London, United Kingdom

Medical Research: What is the background for this study? What are the main findings?

Response: Unplanned hospital admissions in children have been rising for more than a decade placing strain on health care resources in the UK. Unnecessary hospital admission exposes children to hospital acquired infections and an over invasive approach, and is inconvenient for their families as well as adding to pressures on staff dealing with sicker children.

Our team from Imperial College London were interested in assessing the impact of primary care policy reforms on short stay admissions, in England. The reforms were nationally implemented in April 2004 and reduced the availability of primary care physicians for children. Our study, found that reforms coincided with an increase in short-stay admission rates for children with primary care-sensitive chronic conditions and with fewer children’s admissions being referred by a primary care physician.

Over the study period from April 2000 to March 2012, we found that more than half of the 7.8 million unplanned hospital admissions for children younger than 15 years were short-stay admissions for potentially avoidable infections and chronic conditions. The primary care policy reforms implemented in April 2004 were associated with an 8 percent increase in short-stay admission rates for chronic conditions, equivalent to 8,500 additional admissions, above the 3 percent annual increasing trend. Notably, the policy reforms were not associated with an increase in short-stay admission rates for infectious illness.

Medical Research: What should clinicians and patients take away from your report?

Response: The UK primary care reforms, which focused heavily on improving chronic disease management in adults, may have had negative unintended consequences on children with primary care-sensitive conditions. Chronic conditions in children require good quality management in primary care and are sensitive to changes in primary care physicians’ working patterns. Clinicians must be aware of possible knock on effects when quality improvements are implemented to a targeted population.

Medical Research: What recommendations do you have for future research as a result of this study?

Response: The expansion in primary care based activity as a result of reforms has meant that primary care physicians in the UK are struggling to maintain their workload. Amid concerns about rising emergency department visits and short-stay admissions, controversial pilot schemes, increasing primary care access to 7 days, have been introduced. However their effectiveness remains unproven. National implementation of 7 day access would have huge implications for the primary care physician workforce and UK health system budgets. We recommend further research to model clinical and cost effectiveness and survey parental attitudes to weigh best options for avoiding admissions in children.


Elizabeth Cecil, Alex Bottle, Mike Sharland, and Sonia Saxena

Impact of UK Primary Care Policy Reforms on Short-Stay Unplanned Hospital Admissions for Children With Primary Care–Sensitive Conditions Ann Fam Med May/June 2015 13:214220; doi:10.1370/afm.1786

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