• Sriskantharajah Arun-Castro.
• Emergency Medicine, Barts Health NHS Trust, London, United KingdomPrimary Healthcare Survey Research Group, Jersey Consumer Council,States of Jersey, St Helier, Jersey.
• Emerg Med J. 2014 Sep 1;31(9):786-7.

Objectives & BackgroundTo establish whether the need to pay for GP services including consultations, phlebotomy and referrals, affects how households utilise A&E in Jersey. To describe the reasons why households have previously utilised A&E instead of a GP.BackgroundOutside of the NHS, Jersey's primary healthcare service is funded through direct user-fees and co-payments, whilst secondary care including the island's sole Emergency Department is free. The average GP consultation in Jersey costs £37.50.MethodsA postal questionnaire survey exploring household health seeking behaviours was commissioned, designed and piloted following a user-led approach with the Jersey Consumer Council's Primary Care Users Group. A census design was applied to collect data from all households (41,595) during the month of July 2012.Inclusion CriteriaAll households in Jersey, one return per household.Exclusion CriteriaIncomplete/soiled questionnaires. Data were managed in SPSS, with a population-based weighting applied to maximise the representativeness of the sample.ResultsData were obtained from 6,508 households, reflecting a response rate of 16% (6508/41,595).One in three respondents (1934/5998; 32.2%) stated that their household had previously chosen to attend A&E instead of a GP practice. Primary care user-fees were the most commonly cited reason explaining this behaviour, reported by 43.9% of respondents (849/1934).Almost one in five households (1099/5950; 18.5%) stated that they had attended A&E for problems they self-reported as being "neither an accident nor emergency." Both highest (>£104,000) and lowest (<£25,000) annual income groups contributed to this use of A&E. 17.5% (86/492) of high income households and 20.8% (412/1977) low income households reported using A&E for such non-urgent care.ConclusionThis study confirms that in Jersey, GP user-fees create cost-related demand for the Emergency Department.Willingness to pay for primary care does not reflect ability to pay in Jersey, evidenced by both high and low income groups reporting use of A&E for non-urgent problems.Further research is indicated to examine whether A&E cost-related demand would arise if GP user-fees were introduced in the NHS.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

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