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Regarding Matthew's and Jel's comments/query, I'd suggest you review the following papers: "A comparison of general practitioner and usual medical care in an urban A&E department in terms of process, health status and comparative costs. BMJ 1996; 312: 1135-42." "Attitudes of Dublin Accident & Emergency department doctors and nurses towards the services offered by local general practitioners. J Accid Emerg Med 1995; 12; 262-265" "Charges for attendance at A&E Departments and their influence on patient behaviour J Irish Coll Phys & Surg 1996; 25; 1; 14-16" We didn't triage to Primary Care vs A&E, but merely accepted our usual Triage (then very similar to Manchester, now identical) We've also found that it has had a positive influence on all our trainees, but particularly the GP VTS trainees. We also looked at the attendance rates per head of population throughout Dublin and, surprise? surprise?, found much higher rates from areas of social deprivation (unpublished data), despite those patients having free GP, whereas many in the other areas have to pay to see their GP (although they have a potential financial saving coming to A&E!!) As to encourasging Primary Care attenders - you don't need to - they just flock in. We tried a nationwide TV, radio, newspaper and poster campaign to encourage GP attendance rather than A&E for non-emergency attendance and appeared to get a 1-2% fall in new attenders for the duration of the (very expensiive) campaigns. At 22:19 22/09/1998 +0100, you wrote: >In article <00c201bde662$3a6c4700$643d989e@emerg>, Dr Matthew W Cooke ><[log in to unmask]> writes >> >>I do not know of any evidence on whether it encourages primary care >>attenders. I know that some list members will swear it does. But study from >>Nottingham earlier this year showed that areas of social deprivation have >>high primary care attendance rate at A&E. However they also had very high >>rate of GP attendance. >> > >The question is: > >Does the service you provide influence the use of that service? > >Most of us GPs tend to beleive it does - but most of us will also state >that we are probably wrong ;-) > >I do know that whilst I was locuming between GP partnerships one A+E >would halve its cover when I and a similar colleague came on and we >would clear the usual 3 hour wait in 1-1.5 hours to almost zero. I >think as a GP I made firmer decisions re discharge and also re. referral >onwards and would take no flack from admitting teams - eg - I wouldnt >need to await the result of a blood test to justify my referral. > >We were, however, working as A+E docs not as primary care - I think it >would be difficult to make a useful distinction at the door. How about >GP/A+E docs working side by side and providing each other with guidance? > >Cheers :) >-- >Dr Jel Coward > >'There's no such thing as bad weather - just bad clothing" > Anon Norwegian > Pat %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%