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Scant evidence to back primary care in urgent care settings


12 Apr 2016

Locating primary care services in urgent and emergency care settings fails to curb patient demand and improve throughput, researchers say.

Additionally, set up costs dwarf the marginal savings that can be made, according to a review of the available evidence published in Emergency Medicine Journal.

In response to steadily rising numbers of patients seeking emergency and urgent care over the past decade, UK hospitals hit on the idea of co-locating primary care doctors and nurses within the emergency department.

The move was prompted by the theory that many patients arrive at hospital with healthcare needs that can be more appropriately dealt with in primary care.

Although often implemented “at significant cost in many cases,” there has been relatively little evaluation of the effectiveness of this approach, the study found.

The review examined the available evidence published between 1980 and 2015 on unscheduled care given GPs in, or immediately adjacent to, a hospital emergency care facility.

Researchers assessed the impact on demand and throughput (process outcomes), patient satisfaction, and cost effectiveness in 20 relevant studies.

The review found evidence of an increase, rather than a decrease, in demand for urgent/emergency care services.

This is probably because once healthcare resources become available, they will be overused no matter what the quality is like.

If co-located services are not available 24/7, patients may simply turn to emergency care instead, particularly those seeking care out of hours.

The review found some evidence for an improvement in waiting times, but this was not universal, and is likely to be simply due to the increased number of clinicians available to treat patients, suggest the researchers.

Overall, the review found little evidence of an improvement in crowding or throughput from streaming primary care patients out of emergency care.

Nor did it find that diverting emergency care patients to primary care services saved money, because set-up and ongoing indirect costs, which are often not taken into consideration, dwarf the marginal savings to be made.

The researchers suggest: “By blurring the line between emergency and primary care by co-locating services, there is a risk of losing the continuity of care that primary care provides, and encouraging ad hoc health seeking behaviour.”

They continue: “This is likely to lead to confusion, longer pathways and lower degrees of satisfaction with the services being used,” adding that patients are generally quite good at deciding where to access care, with inappropriate choices largely the result of socioeconomic factors and shortcomings in the unscheduled care system.


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