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Sounds like you're in denial. Primary care OOH is already "dead in the water" isn't it? Well, rather, we need to make what's left of it work in a more integrated way with Emergency Care OOH, as Ruth is suggesting. You can't educate the patients, they'll just pitch up to A&E, that's what they do best. And even if you have a perfect primary care system in place, you'll always have a large population in the inner cities who don't have access. They'll keep pitching up to A&E regardless. But looking now at Ruth's question, we have recently started a co-located primary care OOH service, but our triage nurses are very poor at sending primary care patients there. That surprised us at first, as they've spent years whingeing about inappropriate attenders. Could be a reflection of them never doing this for many years, so they can't get their heads round it now. They're also reluctant to send early-in-the-morning A&E attenders to the late-in-the-evening primary care service. One other reason we're only sending about half of our potential primary care patients to our OOH primary care service, is that it's not a "real" primary care service. It's one GP in an ill-equipped room with no practice nurse. So they are quite limited as to what they can deal with. Anyhow, we're soon going to pilot having a practice nurse triaging instead/as well, but I don't think a practice nurse would be very good at triaging - or rather assessing - true A&E cases. In fact I think that would be quite dangerous, but no doubt the GPs on the list will disagree! I suspect we'll go for parallel triage at least for the pilot in the first instance. I think it's just a matter of training and protocols to tighten up our referrals to the primary care service, and the pilot with the practice nurse would be the first step in that process. And finally, those we do deem appropriate for the OOH primary care service are NOT given a choice about it. That would be a disaster, I think, as many would then simply "choose" to be seen in A&E. I can't see the point of giving them a choice, as they're being sent to the most appropriate point of healthcare for their needs. Adrian Fogarty Royal Free Hospital London ----- Original Message ----- From: "McCormick Simon Dr, Consultant, A&E" <[log in to unmask]> To: <[log in to unmask]> Sent: Friday, October 28, 2005 9:03 AM Subject: Re: GPs triage Hmmm, isn't this sort of thing just an example of trying to divert stuff away from A&E that only turned up because the situation in place wasn't working properly. Sort out ease of access to quality Primary Care and you just don't need that sort of thing. There will always be a bit of crossover between A&E and GP, I think we all accept that, but when one tries to 'divert' patients away in to an already overloaded/failing system aren't we failing these patients? It might not, technically, be our problem but it doesn't always make staff feel any better about it and the patients certainly don't always appreciate it!! Simon McCormick Rotherham -----Original Message----- From: Brown, Ruth [mailto:[log in to unmask]] Sent: 28 October 2005 07:46 To: [log in to unmask] Subject: GPs triage Dear list does anyone work in a UK ED where there is a GP or primary care nurse doing triage of unselected patients at the front door? Our SHA CEO is very keen on the idea and I would like to hear from anyone how it works. Does the GP do 24/7 triage, do they triage only minors or majors as well and what are the outcomes in terms of patients sent to primary care vs secondary (ED) and benefits/costs/risks. Thanks Ruth Ruth Brown FRCS FFAEM Emergency Medicine Consultant