Intended for healthcare professionals


Providing primary care in accident and emergency departments

BMJ 1998; 317 doi: (Published 18 July 1998) Cite this as: BMJ 1998;317:207

Referral back to primary care is cheaper

  1. Chris A J McLauchlan, Consultant of accident and emergency department.,
  2. A Harris, Consultant in accident and emergency.
  1. Royal Devon and Exeter Hospital (Wonford), Exeter EX2 5DW
  2. Accident and Emergency Department, Arrowe Park Hospital, Upton, Merseyside, L49 5PE
  3. Emergency Department, Southampton General Hospital, Southampton SO16 6YD
  4. Sydenham Green Health Centre, London SE26 4TH

    EDITOR–The options discussed by Robertson-Steel for providing emergency primary care1do not apply to many departments. The figure of around 40% of new attenders at accident and emergency departments having problems that could be treated by primary care is not true for all departments. The figure generally refers to busy inner city departments, although managers and politicians often imply that it applies across the board.

    In Exeter, for example, a recent audit involving general practitioners found that only around 4-7% of our new attenders had primary care problems (this proportion was higher at weekends and bank holidays but lower in office hours). Thus for us and similar departments where there is a relatively stable local population and a good general practitioner service, primary care attenders are not a major issue. Providing general practitioner services in accident and emergency would therefore not help such departments and may even create a problem by encouraging primary care attenders to come to the hospital out of hours.

    We agree that a national triage category for primary care attenders would be useful, but such a category would also need to be agreed locally if such patients are to be sent straight back to primary care. The introduction of general practice out of hours cooperatives in Exeter has slightly reduced the number of primary care attenders in our audit. Cooperatives could also enable easy referral from accident and emergency back to primary care. This strategy has the advantages that primary care patients are more likely to receive appropriate treatment from a primary care doctor2and that accident and emergency staff would be able to concentrate on …

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