title: Is referral to emergency care practitioners by general practitioners in-hours effective?
abstract: OBJECTIVE
  To evaluate the cost effectiveness to primary care trusts (PCT) in commissioning general practitioner (GP) referrals in-hours to emergency care practitioners (ECP).
  
  
  METHODS
  A retrospective case note review for patients referred by GPs in-hours to ECP over a 4-month period to ascertain any added value over a GP visit.
  
  
  RESULTS
  In a 4-month period 105 patients were referred. In most cases (90.5%) the ECP was utilised as a substitute for a GP rather than providing any additional skills. Defining an avoided attendance as the ECP undertaking an intervention outside a GP skill set this equated to a 9.5% avoided attendance rate compared with the ECP service standard rate of 60%. This has implications both in terms of financial benefit and ongoing ECP service sustainability.
  
  
  CONCLUSIONS
  There is little value in a PCT commissioning this service as they will pay twice and care must be taken in accepting new referral streams into existing services.
authors.affiliation: Yorkshire Ambulance Service NHS Trust (South), Springhill II, Wakefield 41 Business Park, Brindley Way, Wakefield WF2 0XQ, UK. james.gray@yas.nhs.uk
authors.forename: J T
authors.initials: JT
authors.lastname: Gray
authors.forename: A
authors.initials: A
authors.lastname: Walker
mesh_terms: D003362:Cost-Benefit Analysis; D004632:Emergency Medical Services / Q000191:economics*; D004739:England; D005194:Family Practice / Q000191:economics*; D006801:Humans; D010865:Pilot Projects; D012017:Referral and Consultation / Q000191:economics*; D012189:Retrospective Studies