ABSTRACT
The challenges faced by out-of-hours general practice and accident and emergency (A&E) services have much in common. This chapter shows that employing general practitioners (GP) in A&E departments offers ways of integrating the provision of A&E services and out-of-hours GP services. Since 1948, however, there has been a tendency for GPs to distance themselves from the primary care demand that expresses itself at A&E. GPs have been employed in the department on a sessional basis as primary care physicians. The service was initiated within a research project to test its clinical and cost effectiveness. The primary care workload in many A&E departments is insufficient to make the employment of GPs as A&E primary care physicians a cost-effective option unless linked into the overall organisational arrangements for managing out-of-hours care within the district. The main obstacle to developing more integrated services is usually the attitudes of healthcare professionals and managers.
