Objectives & Background To establish whether the need to pay for GP services including consultations, phlebotomy and referrals, affects how households utilise A&E in Jersey. To describe the reasons why households have previously utilised A&E instead of a GP.

Background Outside of the NHS, Jersey's primary healthcare service is funded through direct user-fees and co-payments, whilst secondary care including the island's sole Emergency Department is free. The average GP consultation in Jersey costs £37.50.

Methods A postal questionnaire survey exploring household health seeking behaviours was commissioned, designed and piloted following a user-led approach with the Jersey Consumer Council's Primary Care Users Group. A census design was applied to collect data from all households (41,595) during the month of July 2012. Inclusion criteria: All households in Jersey, one return per household. Exclusion Criteria: Incomplete/soiled questionnaires. Data were managed in SPSS, with a population-based weighting applied to maximise the representativeness of the sample.

Results Data were obtained from 6,508 households, reflecting a response rate of 16% (6508/41,595).

One in three respondents (1934/5998; 32.2%) stated that their household had previously chosen to attend A&E instead of a GP practice. Primary care user-fees were the most commonly cited reason explaining this behaviour, reported by 43.9% of respondents (849/1934).

Almost one in five households (1099/5950; 18.5%) stated that they had attended A&E for problems they self-reported as being “neither an accident nor emergency.” Both highest (>£104,000) and lowest (<£25,000) annual income groups contributed to this use of A&E. 17.5% (86/492) of high income households and 20.8% (412/1977) low income households reported using A&E for such non-urgent care.

Conclusion This study confirms that in Jersey, GP user-fees create cost-related demand for the Emergency Department.

Willingness to pay for primary care does not reflect ability to pay in Jersey, evidenced by both high and low income groups reporting use of A&E for non-urgent problems.

Further research is indicated to examine whether A&E cost-related demand would arise if GP user-fees were introduced in the NHS.