• J Dale, J Green, F Reid, E Glucksman, and R Higgs.
• Department of General Practice and Primary Care, King's College School of Medicine and Dentistry, London.
• BMJ. 1995 Aug 12;311(7002):427-30.

ObjectiveTo compare the process and outcome of "primary care" consultations undertaken by senior house officers, registrars, and general practitioners in an accident and emergency department.DesignProspective, controlled intervention study.SettingA busy, inner city accident and emergency department in south London.SubjectsPatients treated during a stratified random sample of 419 three hour sessions between June 1989 and May 1990 assessed at nurse triage as presenting with problems that could be treated in a primary care setting. 1702 of these patients were treated by sessionally employed local general practitioners, 2382 by senior house officers, and 557 by registrars.Main Outcome MeasuresProcess variables: laboratory and radiographic investigations, prescriptions, and referrals; outcome variables: results of investigations.ResultsPrimary care consultations made by accident and emergency medical staff resulted in greater utilisation of investigative, outpatient, and specialist services than those made by general practitioners. For example, the odds ratios for patients receiving radiography were 2.78 (95% confidence interval 2.32 to 3.34) for senior house officer v general practitioner consultations and 2.37 (1.84 to 3.06) for registrars v general practitioners. For referral to hospital specialist on call teams or outpatient departments v discharge to the community the odds ratios were 2.88 (2.39 to 3.47) for senior house officers v general practitioners and 2.57 (1.98 to 3.35) for registrars v general practitioners.ConclusionEmploying general practitioners in accident and emergency departments to manage patients with primary care needs seems to result in reduced rates of investigations, prescriptions, and referrals. This suggests important benefits in terms of resource utilisation, but the impact on patient outcome and satisfaction needs to be considered further.

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