Table 2.

Arguments proposed for the potential impact of GPED on ED performance

ED performance and performance indicators
Potential impact	Positive	Negative	No difference	Exemplar quote
Use of investigations/testing	Risk tolerant nature of GPs makes them suitable for working alongside the ED – less likely to order investigations unnecessarily.	GPs lack skills to work in ED. By ‘going native’ and having access to investigations/testing, GPs may lose their unique skills and work similarly to ED doctors.	Whether GPs were given access to investigations varied depending on the GPED model in place and so any impacts associated with this would be negligible.	‘It was suggested that those problems could be better dealt with by primary care clinicians who had the appropriate skills for the job and would be perhaps confident about seeing and treating and discharging without over-investigation’. (Rowan, staff interview, 07)
Admissions	Avoid unnecessary admissions of lower acuity patients and improve patient flow.	If the ED is left with only high-acuity patients, the proportion of ED attendances who are admitted will increase.	Admissions not affected as the population targeted is not those that would be admitted from ED.	‘But I can’t pretend that I think it will make a massive difference on admissions, because the people who are waiting for admission are very largely a different group of people you see’. (Service leader interview, 02)
Waiting time/4-hour Key Performance Indicator	Streaming primary care patients to GP (the most appropriate clinician) reduces the risk of breaching the 4-hour target as lower acuity patients are high in volume and occupy a lot of clinician time.	Diverting patients with minor conditions who are theoretically quick to resolve will increase the acuity of ED work and make improvements in the ‘4-hour target’ less likely. Higher acuity patients are considered more complex and so take longer to manage, increasing the potential for breaching the target.	Number of minor breaches that would need to be converted is too large to see any improvement in ‘4-hour performance’.	‘In theory, if you've taken all the minors, all the sort of streamed patients and minor cases out, you'll have … your staff that are there will be able to devote more time dealing with the majors. And similarly they were hoping that you'd be reducing the volume of patients coming through there but you would hopefully be able to increase the rate the patients were seen. So you would reduce the number of breach patients coming through the main ED department’. (Service leader interview, 07)

ED, emergency department; GP, general practice; GPED, GPs working in or alongside the ED.