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The inappropriate attender
  1. Geoffrey Hughes
  1. Professor G Hughes, Emergency Department, Royal Adelaide Hospital, North Terrace, Adelaide 5000, Australia; cchdhb{at}

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By the time anyone reads this piece, more information and detail may be available than at the time of writing it but, in case you have not heard, the Department of Health’s latest gambit is a proposal to charge general practitioners (GPs) for the treatment cost of some of their patients who visit emergency departments (EDs) and walk-in centres instead of their surgeries; a tariff will be used to cross-charge to GPs when their patients receive basic primary care services elsewhere.

The idea—likely to be in a review by Lord Darzi—appears to stem from the belief that poor access to GP services has driven patients to attend EDs, walk-in centres and minor injury units; as GPs are paid according to the number of patients on their list rather than those they see, primary care trusts are concerned that they pay for some treatments twice.

Chris Ham, Professor of Health Policy and Management at Birmingham University, is quoted in several media outlets as saying that the principle is in use in New Zealand, crediting it …

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  • Competing interests: None.