PRIMARY-CARE IN LONDON - AN EVALUATION OF GENERAL-PRACTITIONERS WORKING IN AN INNER-CITY ACCIDENT AND EMERGENCY DEPARTMENT

Objective-To determine the characteristics of primary care attenders t o St Mary's Hospital accident and emergency (A&E) department, evaluate the effects of the introduction of general practitioners (GPs) on pat ient care in A&E, and make recommendations for the provision of GPs in appropriate A&E departments. Design-Prospective survey over a six wee k period. Methods-Data collected from the attendances of 970 consecuti ve patients triaged with ('minor'' primary care problems, whether seen by A&E doctors or by GPs working in A&E, were analysed. Results-Durin g the study period 1078 patients (16.6%) were triaged as suitable for primary care. The A&E GPs saw 58.4% of these patients. The majority of primary care patients were young British residents, 71.1% of whom wer e registered with a GP. Sixty per cent of patients lived within St Mar y's catchment area. Of those registered patients asked why they attend ed A&E, 27.1% thought their problem inappropriate for their GP. A&E do ctors were more likely to investigate patients and arrange hospital fo llow up than GPs, who arranged community follow up in 80% of patients needing further care. Conclusions-The demand for primary care at St Ma ry's necessitates the provision of a primary care service, albeit for Emergency the first visit only. This can be provided by GPs in A&E. Th e features of the patients using the service suggests that discouragin g first attendance is unrealistic, but using the visit to educate pati ents and return them to the care of the community is not.