title: Streaming primary urgent care: a prospective approach.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: London School of Health Sciences, City University, London, UK. J.Bickerton@city.ac.uk
authors.forename: Jane
authors.initials: J
authors.lastname: Bickerton
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Davies
authors.forename: Helen
authors.initials: H
authors.lastname: Davies
authors.forename: Daniel
authors.initials: D
authors.lastname: Apau
authors.forename: Susan
authors.initials: S
authors.lastname: Procter
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities; D004636:Emergency Service, Hospital; D005260:Female; D017144:Focus Groups; D019538:Health Care Surveys; D006301:Health Services Needs and Demand; D006801:Humans; D008131:London; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D017060:Patient Satisfaction; D011446:Prospective Studies; D012189:Retrospective Studies; D055815:Young Adult