Evaluating effectiveness, safety, patient experience and system implications of different models of using GPs in or alongside Emergency Departments (GPs in EDs)

• Prof Adrian Edwards (PRIME, Cardiff University)
• Philippa Anderson, Swansea University
• Prof Damon Berridge, Swansea University
• Andrew Carson-Stevens, PRIME, Cardiff University
• Dr Alison Cooper, Cardiff University
• Prof Matthew Cooke, University of Warwick
• Prof Jeremy Dale, University of Warwick
• Dr Freya Davies, PRIME, Cardiff University
• Prof Liam Donaldson, Imperial College, London
• Dr Bridie Evans, PRIME, Swansea University
• Dr Barbara Harrington, University of Northumbria
• Julie Hepburn, Patient Representative
• Mr Peter Hibbert, Macquarie University, Australia
• Dr Thomas Hughes, Oxford School of Emergency Medicine
• Alison Porter, PRIME, Swansea University
• Prof Tim Rainer, Cardiff University
• Prof Niro Siriwardena, University of Lincoln
• Prof Helen Snooks, PRIME, Swansea University

• Cardiff University
• Swansea University
• University of Northumbria
• Macquarie University, Australia
• Oxford School of Emergency Medicine
• University of Lincoln

• In this study we investigated GPs working in Emergency Departments to ascertain:
• What are the different ways of working, how are they are organised and how common are they?
• How do they work in practice? Do they do what they were meant to do?
• Hospital admissions, re-attendance, waiting times, patient safety and staff and patient satisfaction
• What are the key factors that lead to a better service?

Davies F, Edwards M, Price D, Anderson P, Berridge D, Carson-Stevens A, Choudhry M, Cooke M, Dale J, Donaldson L, Evans B, Fitzsimmons D, Harrington B, Harris S, Hepburn J, Hibbert P, Hughes T, Hussain F, Islam S, Pockett R, Porter A, Rainer T, Siriwardena AN, Snooks S, Watkins A, Edwards A. The effectiveness, safety, patient experience, and system implications of different models of general practitioners working in or alongside emergency departments. Health and Social Care Delivery Research 2024; 12(10).

McFadzean IJ, Edwards M, Davies F, Cooper A, Price, D, Harrington B, Carson-Stevens A, Dale J, Porter A, Evans B, Siriwardena AN, Hughes T, Anderson P Edwards A. Realist analysis of whether Emergency Departments with primary care services generate ‘provider-induced demand. BMC Emergency Medicine 2022; 22: 155.

Evans BA, Carson‐Stevens A, Cooper A,  Davies F,  Edwards M,  Harrington B,  Hughes T, Price D, Siriwardena AN, Snooks H. Edwards A. Implementing public involvement throughout the research process—Experience and learning from the GPs in EDs study. Health Expectations 2022; 25: 2471-2484.

Cooper A, Carson-Stevens A, Cooke M, Hibbert P, Hughes T, Hussain F, Siriwardena AN, Snooks H, Donaldson LJ, Edwards A. Learning from diagnostic errors when GPs work in or alongside emergency departments: incorporating realist methodology into patient safety incident report analysis. BMC Emergency Medicine 2021; 21: 139.

Cooper A, Carson-Stevens A, Edwards M, Davies F, Donaldson L, Anderson P, Cooke M, Dale J, Evans B, Harrington B, Hepburn J, Hibbert P, Hughes T, Porter A, Siriwardena AN, Snooks H, Edwards A (2021). Identifying safe care processes when GPs work in or alongside emergency departments: realist evaluation. British Journal of General Practice 2021; 71 (713)

Edwards M, Cooper A, Hughes T, Davies F, Sherlock R, Anderson P, Evans B, Carson-Stevens A, Cooke M, Dale J, Hibbert P, Harrington B, Hepburn J, Porter A, Rainer T, Siriwardena AN, Snooks H, Edwards. A classification of primary care streaming pathways in UK emergency departments: findings from a multi-methods study comprising cross-sectional survey; site visits with observations, semi-structured and informal interviews. International Emergency Nursing 2021; 56.

Choudhry M, Edwards M, Cooper A, Anderson P, Carson-Stevens, A, Cooke M, Dale J, Hibbert P, Hughes T, Porter A, Rainer T, Siriwardena AN, Edwards A. Senior clinical and business managers’ perspectives on the influence of different funding mechanisms, and barriers and enablers to implementing models of employing General Practitioners in or alongside Emergency Departments: qualitative study. Health Policy 2021; 125(4):482-488.

Price D, Edwards M, Carson-Stevens A, Cooper A, Davies F, Evans B, Hibbert P, Hughes T, Rainer T, Siriwardena AN, Edwards A. Challenges of recruiting emergency department patients to a qualitative study: a thematic analysis of researchers’ experiences. BMC Medical Research Methodology 2020 20:151.

Cooper A, Davies F, Edwards M, Anderson P, Carson-Stevens A,Cooke M, Donaldson L, Dale J, Evans B, Hibbert P, Hughes T, Porter A, Rainer T, Siriwardena AN, Snooks H, Edwards A. The impact of general practitioners working in or alongside emergency departments: a rapid realist review. BMJ Open 2019 2019;9:e024501.

Cooper A, Edwards M, Brandling J, Carson-Stevens A, Cooke M, Davies F, Hughes T Morton K, Siriwardena AN Voss S, Benger J, Edwards A. A taxonomy of the form and function of primary care services in or alongside emergency departments: concepts paper. EMJ 2019; 36: 625-630.

Cooper A, Carson-Stevens A, Hughes T Edwards A. Is streaming patients in emergency departments to primary care services effective and safe? BMJ 2020;368:m462

Conference presentations and abstracts:

Is there provider induced demand at emergency departments with primary care services? Patient, local and wider system factors described to influence demand for primary care in emergency departments: realist evaluation. EMJ 2021;38: A8. Poster presentation at 999EMS research Forum Conference online 23 March 2021.

Primary care streaming in emergency departments and perceived mechanisms for effectiveness. SWSAPC, 2020.

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. SWSAPC, 2020.

A classification of primary care pathways in EDs: a multi-method study comprising cross-sectional survey; site visits with observations; semi-structured and informal interviews (oral presentation). RCEM Virtual Scientific Conference, 13-14 October 2020.

Emergency department clinical leads’ experiences of implementing primary care services where GPs work in or alongside emergency departments in the UK: a qualitative study (oral presentation). RCEM Virtual Scientific Conference, 13-14 October 2020.

Patients’ motivations and expectations when seeking urgent care at emergency departments and acceptability of primary care streaming: a realist study (oral presentation). RCEM Virtual Scientific Conference, 13-14 October 2020.

Primary care streaming in emergency departments – contexts and mechanisms associated with perceived effectiveness outcomes: a realist evaluation (oral presentation). RCEM Virtual Scientific Conference, 13-14 October 2020.

The role of GPs working in or alongside emergency departments and how this influences clinical decision-making: a realist synthesis and evaluation (poster). RCEM Virtual Scientific Conference, 13-14 October 2020.

Exploring opportunities to improve patient safety where GPs work in or alongside emergency departments: a realist synthesis and evaluation (poster). RCEM Virtual Scientific Conference, 13-14 October 2020.

Challenges of recruiting emergency department patients to a qualitative study: a thematic analysis of researchers’ experiences (poster). RCEM Virtual Scientific Conference, 13-14 October 2020.

Embedding public involvement in a realist evaluation of GPs in Emergency Departments (poster). RCEM Virtual Scientific Conference, 13-14 October 2020.