• care systems
• crowding
• emergency care systems
• management
• management

In this edition of the Emergency Medicine Journal, Dr Cooper and her colleagues explore the facilitators and barriers to the effectiveness of different general practitioner service models in or alongside EDs (GP-ED).1 The availability of these services in the UK expanded in response to a 2017 budget commitment of £100 million to enhance A&E services including the colocation of on-site GP services.2 The authors observed that the demand for ED services is influenced by a range of individual, department and wider system factors, but that colocated GP/ED service models did not reduce attendances and waiting times and had a mixed impact on hospital admissions and length of hospital stay.1

The findings are not surprising, as they align with international experience.3–5 Specifically, Ramlakhan et al 3 found little evidence to support the implementation of colocated urgent care models and Cooper et al 5 found little evidence that the presence of GPs in the ED freed up ED staff for emergency care. It appears that colocated GP services tend to draw patients from other community services or create additional demand, and have limited impact on ED demand.

It is harsh to be critical of the policy as generally public policy responses around the world to the challenge of crowded emergency health services often respond to the advocacy of those who lack a clear understanding of the science and tend to be driven by prejudice and opinion.

My professional career spanning clinician, system manager and academic has coincided with the modernisation and upgrading of emergency health services around the world. This has been characterised by the new medical specialty of emergency physician, specialised emergency nurses and the new …