Overview: A&E Acute Admissions

The Primary Care Foundation was commissioned by the Department of Health in May 2009 to carry out a study across England of the different models of primary care operating within or alongside emergency departments. We were asked to provide a viable estimate of the number of patients who attend emergency department with conditions that could be dealt with elsewhere in primary care.  The work was carried out by drawing on expertise from a reference group, a literature review, undertaking visits to departments and also carrying out a web based survey with completion by emergency departments, primary care Providers working in or alongside emergency departments and the commissioners of these services. The report was released in March 2010 (click HERE)

The number of primary care clinicians based within or alongside emergency departments has expanded rapidly in recent years, promising better care for patients who do not need emergency department services and a reduction in admissions.

Primary care practitioners can enhance emergency departments by bringing vital skills and expertise to a multi-disciplinary team. To achieve this, managers and clinicians need to develop strong working relationships. Building mutual respect takes time, but it is vital if initiatives of this kind are to lead to a more integrated service. As one GP put it “if everyone is involved it becomes seen as a joint baby, not a primary care service in their midst”.

Successful schemes are the product of sustained attempts to test out new ideas, learn from each other and improve patient care, based on clear recognition of the skills of each group of clinicians and mutual respect. However, in practice there can be a clash of cultures, with staff divided by different training, approaches to managing risk, governance systems, language and their experience of different case mixes.

The stated reason for introducing primary care services is often to improve patient care.  Yet we found in many cases the main drivers are, in fact, reducing costs and helping to meet the four-hour waiting time target.  The argument is that the payment by results tariff is more costly than a consultation with a primary care clinician and that the higher tariff for a patient who is admitted can act as an incentive to admit, an effect magnified by pressure to meet the waiting time target. 

In this context, primary care clinicians may appear to represent a challenge to the financial viability of a hospital trust. Simply adding primary care practitioners may create short-term savings for commissioners but, without commensurate savings being made or other benefits being realised, there is no saving to the NHS or tax-payer. In contrast, services that are integrating urgent care and developing local tariffs, that incentivise all partners to work in the patients’ best interests, appear to be heading in a more promising direction. In time, an overall cost reduction may be achieved from this approach.

About Us

The Primary Care Foundation was established to support the development of best practice in primary and urgent care.  The three Directors bring different skills and perspectives to understanding primary and urgent health care - for more details click below:

David Carson

Rick Stern

Henry Clay



Latest News

New on-line registration for the potentially avoidable appointments audit

The Primary Care Foundation were selected by NHS England to further improve and automate the audit of potentially avoidable appointments. We are now building a new website with Method Analytics that will make it much easier for any practice to register online, will simplify data collection for clinicians, and will allow for instant reporting on results. The reports will be much easier to understand and will signpost other support. And it will remain free to use for all practices in England.

We are now ready to go live with a new ‘test’ site. We are confident it is already easier to use but we are keen to get any feedback from practices before the new website is fully up and running.

If you are a practice in England and you want to register, CLICK HERE and click on ‘register here to create a practice audit!’ You will be guided through registration and how to set up your clinicians to take part in the audit.  This is a new test site, so if you notice anything that doesn’t look right, or could be made easier, just let us know.  And the same for your clinicians as they enter data – any feedback at the moment – good or bad – would be really helpful … just email us This email address is being protected from spambots. You need JavaScript enabled to view it.


What do we mean by an ‘avoidable appointment?

The latest blog by Rick Stern ‘If only …’ explores the idea of avoidable appointments, what practices have gained from the audit, and what might be possible with further investment in general practice. It is available HERE and will also be published in Health Care Leader.


Are there any simple lessons for practices looking to improve access?

A feature article in Management in Practice by Rick Stern reviews what we have learned from working with over 1,500 practices across the UK – you can read the full article HERE  


Integrated Urgent Care – how to make NHS 111 work

A lead article for Health Care Leader by Henry Clay describes a financial and capacity model developed for NHS England, the potential benefits and pitfalls, and what we have learned from working with a dozen areas to apply the model. The article is available at HERE and a fuller version with a number of explanatory graphs can be downloaded HERE


Integrated Urgent Care – opportunity for support to your locality

We have developed a financial model for the Integrated Urgent Care Team at NHS England that focuses on the NHS 111 and OOH ‘front end’ to an integrated urgent care system (but also looks at the cost of onward referrals to other services). This is proving to be an invaluable tool for both commissioners and providers. It is now available to use and NHS England have also agreed to support some sites to setup and work through the model with PCF’s Henry Clay who developed the model. For further information please contact Henry on This email address is being protected from spambots. You need JavaScript enabled to view it.


We are now supporting over 1,500 practices across the UK to manage access and urgent care

Our support for general practices looking to improve access for patients and streamline the management of urgent care continues to expand. Based on a web based tool, developed out of our work commissioned by the Department of Health, we collect practice data for one week and prepare a report for each practice looking at how you compare to others and explore what this means for making practical changes in the way you work. We are regularly improving the format of our reports for practices based on constant feedback. If you would like to see an example report, CLICK HERE.  If you want to know more about how we might work with you please contact Rick Stern on  This email address is being protected from spambots. You need JavaScript enabled to view it.  or call on 07709 746771.