Regular readers will know that we often use this space to comment on the way that patients flow through the emergency department, whether they are discharged or admitted. In doing so we take note of (and occasionally pass comment on) the many and varied solutions put forward by different organisations to try and improve this problem. The title of this month's editorial is the same as that given to a thoughtful paper published in the British Medical Journal in September last year;¹ in effect, it is an essay questioning current dogma on how we approach the issue and offers guidelines for future strategies and is well worth studying.

Here is a précis of some of its messages:

• Emergency admissions in the National Health Service (NHS) are targeted in the drive to improve quality of care and save money.

• Most attempts to reduce emergency admissions focus on people at high risk.

• NHS admission rates from primary care practices are under increasing scrutiny as it is believed …