Background There has been a year-on-year rise in attendance at A&E departments (EDs) in Greater Glasgow and Clyde (GGC) since 2015/16, despite the opening of alternative units such as medical assessment units and minor injury units (MIUs), and subsequent falling emergency admission rates. This study aims to understand why people choose to attend EDs.

Methods All five EDs in GGC were surveyed over 3 weeks in November/December of 2019. Only those not in crisis were included in the survey. A total of 1196 people were surveyed. Qualitative methods were used to analyse the text data, while chi squared tests compared quantitative data between hospitals. Demographic representativeness was assessed using November/December 2018 attendance data.

Results Less than a third of survey respondents believed that they had a medical emergency. 42% were advised to attend by a health practitioner. Twelve per cent attended at A&E because they could not get a GP appointment with no significant difference between hospitals. Convenience was also cited as a factor and the feeling that this would be the quickest and best place for the person to attend. One third of the four ED respondents tried to get a GP appointment before coming to A&E, ranging between 28.7% and 42.2% (p=0.008). Among the adult patients, approximately a third were given a same day appointment with their GP, and a half were offered an appointment within 48 hours. However, 11.5% were told they would have to wait more than a week, ranging between 9.6% and 16.0% (p=0.009). 86.3% of children were given same day appointments. 62.5% were aware of an alternative service that could treat their urgent health need; almost half cited their GP, yet only 33% attempted to contact them. MIUs were also cited as an alternative option; over half of respondents across the four EDs attended due to an injury. Only a fifth of respondents sought advice from a health website, while half had a long term health condition.

Conclusion The study indicates that attendance by a proportion of patients could be avoided. The convenience and relatively short wait associated with attendance at A&E is recognised by the public. Inability to access GPs in a timely manner is an issue, as is the perceived role of GPs. The large proportion of people attending with injuries suggests underutilisation of, or a need for more, MIUs. Health websites should be promoted, especially to those with long term conditions.