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In the context of this article, access to urgent health care is defined by the patient and carer's needs whenever required and thus includes needs for urgent help both within ‘routine’ hours and outside of normal hours.

The current systems to deliver urgent or emergency care have evolved over time and are often complex for patients, carers and healthcare providers, with poor knowledge of the available services by all parties. These historic developments combined with some recent well-intentioned service changes have, to date, not delivered the intended benefits. Indeed, the demand for urgent and emergency care is largely predictable for both primary care and secondary care,1 2 and much of the variation relates directly to the healthcare systems we have designed.

‘Reforming emergency care’3outlined a blueprint of care that promoted the further development of services including NHS walk-in centres and telephone advice services such as NHSDirect/24. To some extent these have added to the complexity of the system by altering patient flow and access without always capturing local systems and knowledge. Local services have also developed in an ad hoc way rather than follow an integrated plan, partly because of the tension between policies intended to promote integration and those designed to increase patient choice. We have in essence maintained or created multiple access points when the intention was to simplify.

Our current system also controls access to some services and not others, and access can vary by time of day and day of the week. Emergency departments effectively and uniquely provide open access to advice, diagnosis and treatment 24h a day, 7 days …