Accident and emergency department (A&E) visits and ambulance utilisation are rising in the UK despite a very strong network of GPs and universal coverage. The renegotiation of the GP contract has created a new gap in services in some parts of the country, where there are insufficient GPs to cover the emergency out-of-hours workload. Patients’ perceptions of their clinical problem and their GPs’ availability has changed such that their default position is increasingly to attend A&E. The NHS began to address this issue some years ago by …