title: Co-locating primary care facilities within emergency departments: brilliant innovation or unwelcome intervention into clinical care?
abstract: The management of a regional hospital in New Zealand is proposing to co-locate a primary care facility within the local emergency department (ED). This article reviews the reasons for this proposal which include overcrowding of ED, so-called 'inappropriate' attendees, and provision of 24-hour primary medical services for Dunedin City. While the proposal seems to have some intuitive merit, the attribution of overcrowding in ED to attendance by GP-type patients is simplistic; it does not address how patients are processed within ED or how they are transferred to wards later if required ('access block'). This article also discusses some other unresolved issues including the implications of recent funding arrangements in primary care and risk management.
authors.affiliation: Department of General Practice, University of Otago, Dunedin, New Zealand. hwilson@gp.otago.ac.nz
authors.forename: Hamish
authors.initials: H
authors.lastname: Wilson
mesh_terms: D003365:Costs and Cost Analysis; D003695:Delivery of Health Care / Q000639:trends*; D004635:Emergency Medicine / Q000458:organization & administration; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005194:Family Practice / Q000458:organization & administration; D006297:Health Services Accessibility / Q000458:organization & administration; D006767:Hospitals, District / Q000458:organization & administration*; D006801:Humans; D007400:Interprofessional Relations; D009520:New Zealand; D015279:Organizational Culture; D009936:Organizational Innovation; D011320:Primary Health Care / Q000458:organization & administration*; D012308:Risk Management / Q000458:organization & administration; D014218:Triage / Q000379:methods