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Taxonomy of the form and function of primary care services in or alongside emergency departments: concepts paper
  1. Alison Cooper1,
  2. Michelle Edwards1,
  3. Janet Brandling2,
  4. Andrew Carson-Stevens1,
  5. Matthew Cooke3,
  6. Freya Davies1,
  7. Thomas Hughes4,
  8. Katherine Morton2,
  9. Aloysius Siriwardena5,
  10. Sarah Voss2,
  11. Jonathan Benger2,
  12. Adrian Edwards1
  1. 1 Division of Population Medicine, School of Medicine, Cardiff University, UK
  2. 2 Faculty of Health and Applied Sciences, The University of the West of England, Bristol, UK
  3. 3 Warwick Medical School, University of Warwick, Coventry, West Midlands, UK
  4. 4 Emergency Department, John Radcliffe Hospital, Oxford, Oxfordshire, UK
  5. 5 Lincoln School of Health and Social Care, University of Lincoln, Lincoln, Lincolnshire, UK
  1. Correspondence to Dr Alison Cooper, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff CF14 4YS, UK; CooperA8{at}


Primary care services in or alongside emergency departments look and function differently and are described using inconsistent terminology. Research to determine effectiveness of these models is hampered by outdated classification systems, limiting the opportunity for data synthesis to draw conclusions and inform decision-making and policy. We used findings from a literature review, a national survey of Type 1 emergency departments in England and Wales, staff interviews, other routine data sources and discussions from two stakeholder events to inform the taxonomy. We categorised the forms inside or outside the emergency department: inside primary care services may be integrated with emergency department patient flow or may run parallel to that activity; outside services may be offered on site or off site. We then describe a conceptual spectrum of integration: identifying constructs that influence how the services function—from being closer to an emergency medicine service or to usual primary care. This taxonomy provides a basis for future evaluation of service models that will comprise the evidence base to inform policy-making in this domain. Commissioners and service providers can consider these constructs in characterising and designing services depending on local circumstances and context.

  • emergency departments
  • primary care
  • emergency care systems, primary care

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  • Contributors Authors were involved in conception and planning of the work that led to the manuscript (AC, AC-S, FD, MC, TCH, ANS, SV, JB and AE) or acquisition, analysis and interpretation of the data (ME, KM and JB) or both. Authors have approved the final submitted version of the manuscript.

  • Funding This work was supported by the National Institute of Health Research (NIHR) Health services and Delivery Research (HS&DR) Programme, project numbers 15/145/04 and 15/145/06.

  • Disclaimer The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.

  • Competing interests JB is seconded part time to the post of National Clinical Director for Urgent Care at NHS England.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient and public involvement This work has benefitted from strong patient and public contributions from study co-applicant and steering committee team members (BE, JH, BH, SD, MR, AG, JT) and stakeholder conference participants.

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