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pandora jewelry This may reflect limitations in the sensitivity of triage practice or a clinical approach of junior medical staff that includes a propensity to intervene.Key messagesKey messagesTriage can be adapted to fulfil this purpose and differentiate patients into primary care and accident and emergency groupsThe differences in the characteristics and care received by the two groups are not as distinct as expectedThis may reflect limitations in the sensitivity of triage practiceor aspects of the clinical approach of junior medical staffresulting in a propensity to interveneThe problems patients present to hospital accident and emergency departments overlap considerably with those that are commonplace in general practice. Numerous studies have analysed attendances retrospectively and suggested that one third to two thirds of patients attend accident and emergency departments with problems that could have been managed appropriately in general practice1 2 3 4 5 6 7; this pattern of accident and emergency usage seems to be international.8 9 10 11 12 13From the perspective of the accident and emergency service this has been portrayed as problematic, contributing to “inappropriate” utilisation of hospital resources and expertise, prolonged waiting times, and staff stress. The attitudes of staff may be openly or covertly hostile.14 Local general practitioners receive blame for failing to provide sufficiently comprehensive and accessible services,15 and patients may be censured for misusing the accident and emergency service.16The report of the Royal Commission on the National Health Service stated that “where the tradition of using [accident and emergency departments for primary care] is strong, it may be preferable for the hospital to accept this role and make specific arrangements for fulfilling it, rather than to try and resist established local preferences.”17 More recently, developing accident and emergency departments’ role as primary care providers has been supported by the National Audit Office and the Tomlinson Inquiry.18 19 Outside Britain, general practitioners have been appointed in Australian accident and emergency departments,8 and many emergency departments in the United States include walk in facilities staffed by physicians on family practice residency programmes.In 1988 a project was initiated at King’s College Hospital to study the provision of primary care in the accident and emergency department and to develop a more integrated model of service pandora jewelry.