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The question is not whether GPs are better than A and E doctors at seeing primary care conditions- clearly they are (and I think that the original paper to which Dr Ray refers is Dale J. Lang H. Roberts JA. Green J. Glucksman E. Cost effectiveness of treating primary care patients in accident and emergency: a comparison between general practitioners, senior house officers, and registrars. BMJ. 312(7042):1340-4, 1996 May 25- which showed GPs to more cost effective than A and E registrars, not just SHOs. Not sure about consultants.). It is whether A and E or general practice is the best place to see these patients. If you've triaged a patient as having a primary care problem, why not just send them to a GP? (Our departments don't employ specialists in any other areas- we refer the patients). Reinforcing the message that it is appropriate to call 999 because the GP out of hours is busy is not a good idea. (Also, I'm a bit opposed to the general idea that A and E deals with other specialties patients if it's out of hours). Agree with comments from others that the triage category is not a good guide as to which patients have primary care problems. Does anyone have any protocols for nurses directing patients to more appropriate or cost effective services from triage? Matt Dunn