Primary care in accident and emergency and general practice: a comparison.

This paper reviews the way in which literature describing 'inappropriate' attenders at Accident and Emergency (A & E) departments in Britain has suggested that they could be provided for in General Practice and that their attendance at A & E departments therefore implies a 'failure' of general practice in urban areas. One problem with much previous research is that 'inappropriate' attenders have been retrospectively identified. The comparative survey of attenders at a London A & E department and patients visiting their GP in the same district reported here prospectively identified A & E attenders with primary care problems and examined the differences between them and the GP attenders. Patients attending the hospital A & E department were similar to the GP attenders in terms of socio-economic indicators, but had problems which were not typical of the general practice workload and were in different circumstances. The results suggest that there will be a continuing demand for hospital-provided primary care in urban areas, and that attempts to deflect such care to the community will meet with limited success.