Streaming primary urgent care: a prospective approach

Prim Health Care Res Dev. 2012 Apr;13(2):142-52. doi: 10.1017/S146342361100017X. Epub 2011 Jul 21.


Aim: To identify the appropriate service provider attendees of emergency departments (EDs) and walk-in centres (WiCs) in North East London and to match this to local service provision and patient choice.

Design: An anonymous patient survey and a retrospective analysis of a random sample of patient records were performed. A nurse consultant, general practitioner (GP) and pharmacist used the presenting complaints in the patients' records to independently stream the patient to primary care services, non-National Health Services or ED. Statistical analysis of level of agreement was undertaken. A stakeholder focus group reviewed the results.

Subjects and setting: Adult health consumers attending ED and urgent care services in North East London.

Results: The health user survey identified younger rather than older users (mean age of 35.6 years--SD 15.5), where 50% had not seen a health professional about their concern, with over 40% unable to obtain a convenient or emergency appointment with their GP. Over a third of the attendees were already receiving treatment and over 40% of these saw their complaint as an emergency. Over half of respondents expected to see a doctor, one-quarter expected to see a nurse and only 1% expected to see a pharmacist across both services, although WiCs are nurse-led services. More respondents expected a prescription from a visit to a WiC, whereas in the ED a third of respondents sought health advice or reassurance.

Conclusion: A number of unscheduled care strategies are, or have just been, developed with the emphasis on moving demand into community-based services. Plurality of services provides service users with a range of alternative access points but can cause duplication of services and repeat attendance. Managing continued increase in emergency and unscheduled care is a challenge. The uncertainties in prospective decision making could be used to inform service development and delivery.

MeSH terms

  • Adult
  • Ambulatory Care Facilities
  • Emergency Service, Hospital*
  • Female
  • Focus Groups
  • Health Care Surveys
  • Health Services Needs and Demand*
  • Humans
  • London
  • Male
  • Medical Audit
  • Middle Aged
  • Patient Satisfaction*
  • Prospective Studies
  • Retrospective Studies
  • Young Adult