Will alternative immediate care services reduce demands for non-urgent treatment at accident and emergency?

Objectives-To estimate the potential of general practice, minor injury unit s, walk in centres and NHS Direct to reduce non-urgent demands on accident and emergency (A&E) departments taking into account the patient's reasons f or attending A&E. Methods-A questionnaire survey and notes review of 267 adults presenting to the A&E department of a large teaching hospital in Sheffield, England, tri aged to the two lowest priority treatment streams, was conducted over seven weeks. Using defined criteria, patients were classified by the suitability of the presenting health problem to be managed by alternative immediate ca re services or only by A&E, and also by the likelihood, in similar circumst ances, of patients presenting to other services given their reasons for see king A&E care. Results-Full data were obtained for 96% of participants (255 of 267). Using objective criteria, it is estimated that 55% (95% CI 50%, 62%) of the heal th problems presented by a non-urgent population attending A&E are suitable for treatment in either general practice, or a minor injury unit, or a wal k in centre or by self care after advice from NHS Direct. However, in almos t one quarter (24%) of low priority patients who self referred, A&E was not the first contact with the health services for the presenting health probl em. The reason for attending A&E cited most frequently by the patients was a belief that radiography was necessary. The reason given least often was s eeking advice from a nurse practitioner. Taking into account the objective suitability of the health problem to be treated elsewhere, and the reasons for attending A&E given by the patients, it is estimated that, with similar health problems, as few as 7% (95% Cl 3%, 10%) of the non-urgent A&E popul ation may be expected to present to providers other than A&E in the future. Conclusions-The increasing availability of alternative services offering fi rst contact care for non-urgent health problems, is likely to have little i mpact on the demand for A&E services.