• urgent care
• access to care
• emergency care systems, primary care
• emergency care systems, emergency departments

The dilemma of balancing the conflicting priorities of improving access to emergency services with the need to manage demand has been an issue since such services were first formally established. Dominique Jean Larrey, a surgeon in Napoleon's army, improved access times for battlefield casualties by introducing the forward field hospital and ‘ambulance volante’ to transport casualties to these hospitals.1 ,2 The unintended consequence was that field hospitals became overwhelmed by the number of casualties. This led Larrey to introduce ‘Le triage’ (the sort) to ensure that resources were allocated based on clinical need. This was the first formal description of initiatives to improve access while also managing demand.

The Platt report (1962) reviewed the then 789 casualty departments in England and Wales and noted that these departments were generally overwhelmed by minor cases that could have been treated by a general practitioner and proposed that the name ‘casualty service’ should be altered to ‘accident and emergency service’ and the number be …