Table 4.

Arguments proposed for the potential impact of GPED on ED attendance

Service access
Potential impact	Increase	Decrease	No difference	Exemplar quote
GPED as a replacement primary care service	GPED becomes a replacement GP service.		Streaming patients to most appropriate professional. Average person uses ED less than once a year so unlikely to become the main source of general practice.	‘I guess my personal view is I think they’re probably putting GPs on hospitals because they’ve realised people are fed up of waiting to get an appointment at the GPs and they're going to hospitals, so they're not really fixing the problem there’. (Redwood, patient interview, 02)
Increase ‘inappropriate’ attendance	Same-day access to a GP may encourage ‘inappropriate’ attendance.	Many patients present with high acuity needs, so not the same as a walk-in centre in terms of supply.		‘But I think, I think what it, what it does do is that, it further reinforces the concept if you’ve got an urgent and emergency care problem you go to ED, because not only is the ED and x-rays and prescriptions there and all the rest of it there, but now you’ve got primary care there as well…I kind of think it acts as a supply site driver’. (Service leader interview, 005)
Increase demand on ED	Peaks in attendance when general practice surgeries are closed.		Patients unaware of GPED service.	‘It hasn’t been well publicised…patients, I don’t think most patients will be aware of it. I think that given they get treated in an emergency department they will probably not recognise that there is, that there’s a GP service…’ (Service leader interview, 01)

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