Over the period 1974-85 the range of mean annual new attendance rates at Accident and Emergency departments among English health districts was 36-673 per 1000 residents. The socio-economic diversity of these districts explained only one-third of the variation. The rates rose significantly (p less than 0.05) in 89 per cent of districts over the twelve years. Again, socio-economic variation only partly explained differences in district trends. Increases were greater among districts with higher mean rates. In order to plan first-contact care rationally we need a better understanding of the factors underlying these trends.
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