Predicting the future from evidence

“Prediction is difficult, especially about the future” goes the saying.

But when it comes to predicting an outcome, based on evidence from past observations, the thrill comes from seeing it come true.  We are now entering that stage with some of the early adopters of Patient Access.

How did this come about?  I’m enjoying James Le Fanu’s “Rise and Fall of Modern Medicine” at the moment, as he describes the discovery of new wonder drugs in the mid 20th century, from penicillin onwards.  A common feature is the role of luck, circumstances, chance meetings, even freak weather, often people looking for something else when a breakthrough happened.  Even when they found a sudden benefit for patients, they didn’t know why it worked.  I wasn’t looking for a GP innovation, telephoning all the patients, when I asked how we might turn back the rise in emergency demand.  But having found what we now call Patient Access in operation in several dozen practices, the effect on A&E attendances seemed remarkable.  ”Well, they are probably just good practices anyway” said some.

Two years later we know more, as the new adopters are starting to show the same outcomes predicted by the observation above.  Like the drugs researchers, we’ve seen side effects and a few reversals, but many more successes.  We’ve learned more from small scale trials and case studies, and measured the effects in practice in great detail, helping people to fine tune their operations.

Now we are seeing the effects in A&E.  Thurmaston, Leicester saw its attendances drop 49% in a year (CCG figures), while The Elms in Liverpool has stayed among the lowest A&E attending practices in the city, 40% below the average.  We don’t yet have comprehensive data (please help if you can), and we are planning larger scale studies with experimental designs.  But the signs are promising, as predicted, and as more practices mature, we will continue to track the outcomes.

Promising data leads as ever to more questions.  Is there a dose response, where for example speed affects A&E by some function?  We don’t know yet.  We do know that continuity goes up for most practices.  Rose Garden in Edinburgh is achieving 95% month by month.  Richard Baker’s team showed that continuity is linked with lower referrals, the Stour case study supporting the observation.  Will we see this prediction come true over time?

Thanks for reading, welcome to the new site and watch this space as the story of a GP innovation unfolds.

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