ABSTRACT
In any attempt to explore the difficulties and tensions in the NHS, accident and emergency (A and E) services provide, perhaps more than any other sector of the Service, something of a test case. Once the hospital’s A and E department becomes progressively opened-up as a primary mode of access to medical care, and hence alternative to GP referral, the perceptions of a single medical group can no longer determine the utilisation patterns of particular services. Before documenting some of the salient features in the changing volume and distribution of patient demands’ upon A and E services, it is relevant to note the pathways patients take in their attempts to gain access to the medical care system. The link between primary services and accident and emergency services can either be expressed in terms of their substitutability or in terms of their complementarity. To view the issues and their resolution solely in terms of medical manpower is to overlook wider considerations.
