Cost of employing general practitioners in department may outweigh savings

BMJ 1995; 311 doi: https://doi.org/10.1136/bmj.311.7017.1438a (Published 25 November 1995) Cite this as: BMJ 1995;311:1438
  1. Derek P Burke,
  2. Najam Rashid
  1. Senior registrar, accident and emergency medicine Walsall Manor Hospital, Walsall
  2. Senior registrar, accident and emergency medicine Heartlands Hospital, Birmingham

    EDITOR,--Jeremy Dale and colleagues state that important benefits in terms of resource allocation might result if general practitioners were employed in accident and emergency departments to manage patients with “primary care” type problems.1 Although this may be the case at King's College Hospital, where the rate of patients attending with such problems is 41%, in areas of Britain with lower primary care attendance rates the cost of employing general practitioners might outweigh any savings from reductions in investigations.

    The accident and emergency department at the Royal Hospital, Wolverhampton, is in an inner city area and sees roughly 76000 new patients a year. A prospective study was undertaken between 12 July 1993 and 19 September 1993 to determine the size and epidemiology of the primary care problem. Primary care patients were defined as those whose condition could best be managed by a general practitioner (for example, those with ear or throat infections, urinary tract infections, or chronic back pain). Staff were trained so that consistency of categorisation was assured. A total of 13453 new patients were seen, 13184 (98%) of whom had a general practitioner (compared with 91% at King's College Hospital). Altogether 461 (3.4%) patients were judged to have problems that would have been more appropriately managed by their general practitioner. Three hundred and twenty seven (71%) primary care attenders presented on Monday to Friday, two thirds of them presenting during surgery hours. On average, therefore, the Royal Hospital saw seven primary care attenders a day, most of whom attended when access to their general practitioner was easiest. The cost of employing general practitioners to deal with such a small number of patients is unlikely to outweigh the cost of excess investigations.

    Why two similar departments should have such a wide variation in the primary care attendance rate is unclear, but this comparison highlights the need to exercise caution when extrapolating from the experience of one department to that of another. We believe that the individual accident and emergency departments should analyse the size and epidemiology of the primary care “problem” locally before adopting expensive solutions.


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