Primary medical care in a paediatric accident and emergency department.

The characteristics of a random sample of 853 children who attended the accident and emergency department of the Royal Belfast Hospital for Sick Children were studied prospectively to determine the extent to which the department was being used to provide primary medical care. Direct parent referrals accounted for 69% of all attendances with a further 21% referred by the family doctor. Parental preference and accessibility were the main reasons given for choosing to attend the department with the latter significantly higher among out-of-hours attendances. However, only 37 of the 585 parent referrals had made an attempt to contact the family doctor. Overall, 33.9% of children were felt to be inappropriate attenders, i.e. were neither accident nor emergency cases, and the proportion was highest among the parent-referred groups. The present financial restraints facing the National Health Service make it uneconomical to provide primary medical care at both hospital and community level. However, the level of demand for the accident and emergency department, together with the attitudes of those who attend, make it unlikely that a more rational use of resources will be achieved in the foreseeable future.