Emergency medicine and "acute" general practice: comparing apples with 0ranges

Abstract

Emergency Departments (EDs) operate at the interface between the inpatient and ambulatory sectorsof health care. Because of shared funding between the Commonwealth and States for ambulatory care,there has been intense focus on the ED patient population, and the potential to shift the locus of carefor non-inpatients.One of the frequently cited models for the provision of after-hours GP services is the Balmain GeneralPractice Casualty (GPC). This paper analyses the GPC model, looking in detail at casemix, clinicalquality, waiting times and cost-effectiveness. It is argued that the services provided and the casemix ofthe patient population of GPC and EDs are distinctly different. Cost-effectiveness for GPC has notbeen objectively established.Health service planning should recognise the distinct but complementary roles of general practice andemergency medicine. Evaluation of alternative models of service provision should critically examine theavailable evidence, and comparisons should be based on a precise analysis of equivalent services.