Senior clinical and business managers’ perspectives on how different funding mechanisms and models of employing GPs in or alongside EDs influence wider system outcomes. Qualitative Study.

Problem

Emergency Departments (EDs) across England and Wales are facing increasing pressures, with attendances rising and waiting time targets being missed. In England, NHS policy has been implemented to tackle this by introducing GPs in or alongside EDs to see non-urgent patients and free up ED staff. This policy was backed by £100 million in capital investment. However, wide variation exists in the funding streams utilised for the continued operational costs of these services, how they are operationalised and what outcomes they achieve.

Approach

We are completing a qualitative study exploring the perspectives and experiences of senior clinical and business managers to explore and examine the influences of different funding models of employing GPs in or alongside EDs on quality of care, targets and wider system outcomes. 13 Type 1 EDs in England and Wales, operating 3 different models or controls, were selected for the study. We purposively sampled senior clinical and business managers, defined as those within each site with an intimate knowledge of the funding structures in the primary care services. Data from 30 respondents at 11 sites have so far been collected. 30-60-minute semi-structured interviews of respondents, either in groups or one-to-one, conducted by a single researcher, were transcribed and are being coded using NVivo. Data will be thematically analysed.

Findings

The results of this student BSc project will be available by March 2020. Primarily, the study will examine perspectives on different funding models and how these are thought to influence wider system outcomes. As secondary outcomes the study will examine the role that sources of staffing play in influencing these outcomes, and also report on the experiences, challenges and responses in the services from the different models of employing GPs in or alongside EDs.

Consequences

Findings will feed into a wider study commissioned by the National Institute of Health Research (NIHR) to build an evidence base (also patient experience, cost-effectiveness, patient safety) around this policy and inform NICE guidelines and healthcare policy.