Aim To determine the number of presentations to a new Children’s Emergency Department (CED) that could have been managed in primary care.

Methods All Patients were assessed to determine the appropriateness of attendance. Appropriateness was defined as any patient referred from primary care, or requiring any period of observation, a procedure or an investigation, or that were admitted. Patients appropriate for primary care management were defined as children that did not meet the above criteria, had a simple illness with no significant underlying pathology and were green in accordance to the NICE traffic light system. The outcome of all GP referrals was also reviewed.

Results 898 attendances (viral type illness 47%, injuries 32%) were reviewed. 27.4% were deemed more appropriate for primary care with 60% being < 5 years (23% < 1year). The majority (68.6%) were self-referral, 62% from within a 5miles radius and 30% from just 10 of the 111 GP practises.

16% were referred from primary care, 24.3% were admitted. The estimated minimum cost of these additional referrals was £286 520 per year, with 64.2% of these costs being children under the age of 5.

Discussion A large number of attendances to the CED could be managed in primary care. The health system needs to adapt in order to meet users’ needs and continue the ethos of right patient right place right time. Using this audit data the local primary care Clinical Commissioning Group (CCG) and the hospital trust have worked together to implement many changes. The out of hours (OOH) service has been reinstated allowing specific patients to be triaged straight back to the primary care centre, who are prioritising seeing and calling back the under 5 year olds. CED has developed formal care pathways for common illness for use in primary care; CED is in direct liaison with the local GP forums to address concerns. Ultimately, CED services need to adapt to be able to care for an increasing volume of attendances, and primary and secondary care need to “make love not war”.