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Royal College of General Practitioners, British Journal of General Practice, suppl 1(70), p. bjgp20X711185, 2020

DOI: 10.3399/bjgp20x711185



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Emergency Admission Risk Prediction (EARP) tools in primary care to reduce emergency admissions to hospital: clash of evidence and practice

Journal article published in 2020 by Helen Snooks, Mark Kingston ORCID, Alison Porter, Hayley Hutchings, Ian Russell
This paper is made freely available by the publisher.
This paper is made freely available by the publisher.

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BackgroundPolicy initiatives have incentivised use of EARP tools in primary care to reduce emergency admissions. A recently published trial in South Wales found that EARP increased emergency admissions and emergency department attendances without clear benefits. This cost the NHS an additional £76 per patient per year. But the use of EARP in primary care across the UK was unknown.AimTo assess implementation and facilitators use of EARP tools in primary care across the UK.MethodStructured email survey of 235 UK primary care commissioners across the UK.ResultsThere were 148 (87%) of 171 responders (73%) who reported that EARP tools were available in their areas. We identified 39 different EARP tools in use. Access to EARP tools varied widely by country: Northern Ireland (100%), Scotland (91%), England (76%) and Wales (14%). Promotion by NHS commissioners, and engagement of clinical leaders and practice managers were identified as the most important factors in encouraging use of EARP tools. Research evidence was seen as less important. Nearly 40% of areas using EARP reported that they had revised services as a result, but few reported use of EARP for service evaluation.ConclusionThough EARP tools are widely available in primary care, new evidence shows that they are counter-productive. We estimate that by delaying the dissemination of EARP for evaluation NHS Wales saved >£200 million per year. We encourage further research and discussion about next steps in use of EARP tools in emergency admission prevention in the UK.