Understanding the relationship between frequent users of emergency departments and primary care quality: a retrospective observational study in England

• Frequent A&E use burdens the NHS, but how it links to primary care remains unclear • We analysed over 10 million A&E visits to identify frequent users • Primary care quality was measured by 9 indicators across 6,795 practices • Frequent A&E use is associated to more ACSCs and lower patient satisfaction • Policies targeting ACSC prevention and patient experience may reduce frequent A&E use Emergency department (A&E) crowding is a growing issue in many countries, negatively affecting patient outcomes. While demand and supply constraints are known drivers, the link between primary care quality and frequent A&E use remains unclear. To explore the relationship between primary care quality and frequent A&E users in England. We conducted a retrospective observational study using national-level secondary data covering all major A&E attendances in England in 2016/17. We applied negative binomial regression to model the association between GP practice-level counts of frequent A&E users and nine primary care quality measures: the number of admissions with ambulatory care-sensitive conditions (ACSCs) per 1,000 registered patients, clinical performance under the Quality and Outcomes Framework (QOF), and seven GP Patient Survey–based experience indicators. Additional analyses examined total A&E users and total A&E attendances. Frequent A&E users were positively associated with admission rates for ACSCs and negatively associated with patient experience (the proportion of patients recommending their GP and the ability to get same-day appointments). In additional analyses, admission rates for ACSCs were similarly associated with increased total A&E users and total A&E attendance volumes. The ability to see or speak with a preferred GP was associated with a reduction in the total volume of A&E users. The findings highlight the varying aspects of primary care quality that influence frequent A&E users. Policies aiming to reduce A&E demand could focus on improving primary care quality by reducing admission rates for ACSCs and improving patient experience at GP practices.