Is streaming patients in emergency departments to primary care services effective and safe?

Between 10% and 43% of patients presenting to emergency departments can be managed in primary care, according to estimates from observational studies.1234 Increasing demands on emergency healthcare systems have led to the development of different healthcare models, including “streaming” patients presenting with non-urgent conditions to primary care services.5 These strategies are intended to improve patient flow and reduce crowding in the emergency department. In 2017 NHS England made substantial investments for all emergency departments to have co-located primary care facilities so they are “free to care for the sickest patients.”67

However, the evidence for this initiative is weak.89101112 Different service models are described in different contexts using ambiguous terminology. A “co-located” primary care service may deliver patient care in a separate unit to the emergency department, without access to acute diagnostics, thus similar to normal general practice settings. Alternatively, general practitioners may work …