Impact of vertical integration on patients’ use of hospital services in England

Catherine Saunders (Lead Author), Charlotte Davies, Manbinder Sidhu, Jon Sussex

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Background Debate surrounding the organisation and sustainability of primary care in England highlights the desirability of a more integrated approach to patient care across all settings. One such approach is ‘vertical integration’, where a provider of specialist care, such as a hospital, also runs general practices.

Aim To quantify the impact of vertical integration on hospital use in England.

Design & setting Analysis of activity data for NHS hospitals in England between April 2013 and March 2020.

Method Analysis of NHS England data on hospital activity: Accident and Emergency Department (A&E) attendances; outpatient attendances; total inpatient admissions; inpatient admissions for ambulatory care sensitive conditions; emergency admissions; emergency readmissions; length of stay. We compare rates of hospital use by patients of vertically integrated practices and controls, before and after the former were vertically integrated.

Results In the two years after a GP practice changes, for the population registered at that practice, compared with controls, vertical integration is associated modest reductions in rates of A&E attendances (2% reduction [incidence rate ratio (95% CI) of 0.98 (0.96–0.99), P<0.0001]), outpatient attendances (1% reduction [0.99 (0.99–1.00), P=0.0061]), emergency inpatient admissions (3% reduction [0.97 (0.95–0.99), P=0.0062]) and emergency readmissions within 30 days (5% reduction [0.95 (0.91–1.00), P=0.039]), with no impact on length of stay, overall inpatient admissions or inpatient admissions for ambulatory care sensitive conditions.

Conclusion Vertical integration is associated with modest reductions in use of some hospital services and no change in others.
Original languageEnglish
JournalBritish Journal of General Practice
Early online date8 Jan 2024
Publication statusE-pub ahead of print - 8 Jan 2024

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