TY - JOUR T1 - Evaluation of winter pressures on general practice in Manchester: a cross-sectional analysis of nine GP practices JF - BJGP Open JO - BJGP Open DO - 10.3399/bjgpopen20X101138 SP - bjgpopen20X101138 AU - Sinead Millwood AU - Peter Tomlinson AU - Jon Hopwood Y1 - 2020/11/17 UR - http://bjgpopen.org/content/early/2020/11/12/bjgpopen20X101138.abstract N2 - Background: The Nuffield Trust’s report on NHS winter pressure highlights a lack of data for primary care, with a consequential focus on secondary care. Aim: To quantify seasonal variation in workload in primary and secondary care. Design and Setting: Analysis of data for nine GP practices in Greater Manchester with a patient population of 75,421. Method: Descriptive and comparative analyses were performed for winter and summer periods in 2018-19. Data were obtained from the North of England Clinical Support Unit (NECSU) via the Rapid Actionable Insight Driving Reform (RAIDR) toolkit, and EMIS Enterprise clinical audit tools. Results: Accident & Emergency (A&E) attendances increased by 4% (p= 0.035) during winter with no difference in the number of hospital admissions (p=0.668). The number of problems seen in General practice increased by 61% (p<0.001), as did the number of GP consultations 61% (p<0.001). Respiratory diagnoses saw the greatest seasonal variation accounting for 10% in winter, 4% in summer (p<0.001). Self-referral accounted for 70% of A&E attendance in winter, 63% in summer (p<0.001). GP referral accounted for 7% in winter, 6% in summer (p=0.002). Conclusion: General practice observed a greater seasonal increase in presenting patients compared to secondary care. We recommend any winter pressures strategy target both respiratory illness and patients who self-refer to A&E. Transferring 50% of self-referrals in Manchester to GP appointments would achieve a £2.3 million cost saving. Increasing provision in primary care requires funding and increased appointments, but more importantly improved patient opportunities to easily access timely advice and assistance. ER -